G.S. 110-90 · Violation

Name of Operation: THE NEST SCHOOL Facility ID: 34001399 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 1/30/2026 Number Present: 95 Completed Date: 1/30/2026 Age: From 0 To 5 Total Minutes: 450 Time In: 09:00 AM Time Out: 04:30 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 with Ashleigh Meyers, Assistant Director. Krista Lewis, Director, was also present for a portion of the visit. Your program currently operates with a 4-Star license effective 10/23/2025. Restrictions include 1st shift care, meets enhanced ratios and children under 2 ½ years old in rooms with direct exits only. The program’s compliance history was 88% 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 were found in compliance. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. The depth of the mulch could not be measured during today's visit due to ice covering the playground; this will be monitored during my next visit. 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, participating in general routines, and eating lunch during the visit. Six new staff members were reported at this program. The files for these staff members were 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 1/04/2026. A fire drill was recorded 1/09/2026. A shelter-in-place drill for the facility was recorded 1/09/2026. The most recent fire inspection was on 5/15/25. I observed a sanitation inspection was last conducted on 10/20/2025 earning a Superior classification. The program does not participate in off-premise or aquatic activities at this time. The following violations were cited during today’s visit: Violation Number Comment Rule 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. An aerosol can of Febreeze, a spray bottle of Clorox, and a spray bottle of glass cleaner labeled Keep Out of Reach of Young Children were observed in an unlocked cabinet in Space 1; the cabinet has a lock on it, but the lock was not functioning properly and did not lock the cabinet. An aerosol can of Febreeze, a spray bottle of Lysol, and a canister of disinfectant wipes labeled Keep Out of Reach of Young Children were observed greater than five feet from the ground, but in an unlocked cabinet in Space 9. In Space 7, a small keychain with hand sanitizer was observed in a staff bag stored less than five feet from the ground and accessible to children. .2820(b) 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. In Space 5A, a diaper cream was not returned to a parent after 1/08; the “valid to” date was recorded as 12/05/2025, and the “valid from” date was recorded as 1/08/2025. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space 6, a classroom designated for children one year of age, a piece of wrapped peppermint candy, greater than three small screws, and other items small enough to be potential choking hazards for children were observed inside an unlatched drawer less than five feet from the ground. .0604(q) 880 Non-mobile children were enrolled and the center did not have a crib or other approved device to safely evacuate the children in an emergency. Evacuation cribs were not observed in Space 9, a room designated for infants ages nine months to twelve months in age with seven infants currently enrolled. .0604(r) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. The safe sleep record for one infant enrolled in Space 9 was not completed for 1/28/2026; a staff member stated the child was present and napped that day. The safe sleep record for another infant enrolled in Space 9 was not observed to have been recorded since 11/10/2025; administration stated the child was present in the following days, and the child was present during today’s visit. .0606(g) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. A safe sleep policy was not observed posted in Space 9. .0606(b) 898 All electrical appliances were not used in accordance with the manufacturers instruction. Appliances with heating elements, such as bottle warmers, crock pots, curling irons, irons, coffee pots, and/or their cords were accessible to preschool-age children. In Space 7, a portable laminator was observed less than five feet from the ground on a child-sized table; the laminator was plugged in and hot to the touch. .0604(e) 1044 Prior to the expiration date of the qualification letter, the child care provider did not complete and submit required forms to complete a criminal background check (a qualification letter is valid for a maximum of five years for the date of issuance). The Criminal Background Check Qualification Letter for one new staff member expired on 1/19/2026. G.S. 110-90.2(b) & .2703(n)&(o) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. None of the six new staff members’ CBC qualification letters were observed to be linked to the facility’s ABCMS Facility Profile. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A lockdown/ shelter-in-place drill was not observed to be recorded between 7/02/2025 and 1/09/2026. .0604(u);.0302(d)(8) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. In Space 9, the name of the topical medication was not observed recorded on the permission to administer topical ointment form for one child enrolled; this name was added to the form during the visit. In Space 2 the permission to administer topical ointment form for one child enrolled did not have a “valid from” date recorded. This date was added to the form during the visit. In Space 9 the permission to administer topical ointment form for one child enrolled did not have a “valid to” and “valid from” date recorded; these dates were added to the form during the visit. In Space 4, the date the topical medication authorization form was signed by a parent was not observed for one child enrolled; this date was recorded during the visit by administration. The diaper creams for two children enrolled in Space 2 and one child enrolled in Space 4 did not have permission to administer forms on file for review. The medication authorization form for one child enrolled in Space 2 with an emergency medication was not observed on file for review. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before 2/13/2026. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation 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. 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 Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical Assistance Provided During Visit: An aerosol can of Febreeze, a spray bottle of Clorox, and a spray bottle of glass cleaner labeled Keep Out of Reach of Young Children were observed in an unlocked cabinet in Space 1; the cabinet has a lock on it, but the lock was not functioning properly and did not lock the cabinet. An aerosol can of Febreeze, a spray bottle of Lysol, and a canister of disinfectant wipes labeled Keep Out of Reach of Young Children were observed greater than five feet from the ground, but in an unlocked cabinet in Space 9. In Space 7, a small keychain with hand sanitizer was observed in a staff bag stored less than five feet from the ground and accessible to children. All items in each of the three spaces were placed into locked storage during the visit. It is essential for the indoor environment to be free of products which can be harmful to children if handled, ingested, or inhaled. Administration stated they were unaware these items were not in locked storage. You may consider monitoring the space designated for child care daily prior to children arriving to ensure there are no items present which could present a safety hazard to children and that all areas containing these items are securely locked. In Space 6, a classroom designated for children one year of age, a piece of wrapped peppermint candy, greater than three small screws, and other items small enough to be potential choking hazards for children were observed inside an unlatched drawer less than five feet from the ground. All of these items were made inaccessible to children during the visit and were placed into locked storage. In Space 7, a portable laminator was observed less than five feet from the ground on a child-sized table; the laminator was plugged in and hot to the touch. This laminator was unplugged and removed from the classroom immediately by Mrs. Lewis. It is imperative for the indoor environment to be a safe place for children to engage with and explore at all times. Potential choking and burning hazards can cause serious harm to young children. You may consider monitoring the space designated for child care daily prior to children arriving to ensure there are either no items present which could present a safety hazard to children, or that these items are properly stored and secured prior to children’s arrival. A safe sleep policy was not observed posted in Space 9; a safe sleep poster was posted in this space by a staff member during the visit. The safe sleep record for one infant enrolled in Space 9 was not completed for 1/28/2026; a staff member stated the child was present and napped that day. The safe sleep record for another infant enrolled in Space 9 was not observed to have been recorded since 11/10/2025; administration stated the child was present in the following days, and the child was present during today’s visit. It is critical for safe sleep practices and requirements to be current and followed at all times. Visually checking on infants while they are sleeping at least every fifteen minutes decreases the risk of a SIDS death occurring. The staff member and administration stated they were unsure why these records were not present for review. You may also consider keeping a small timer in spaces designated for infants which can be set to sound an alert every 15 minutes while infants are sleeping so staff members do not get busy and accidentally overlook recording a safe sleep check. The diaper creams for two children enrolled in Space 2 and one child enrolled in Space 4 did not have permission to administer forms on file for review. The medication authorization form for one child enrolled in Space 2 with an emergency medication was not observed on file for review. It is critical for a medication administration form to be complete, current, and on file prior to any child receiving medication or having topical medication applied for the health and safety of children enrolled. Ms. Myers notified parents of the medications authorization forms needed during the visit. You may consider requiring parents to drop off all medications/ required forms to the office for review by administration before allowing them to be stored in classrooms. Evacuation cribs were not observed in Space 9, a room designated for infants ages nine months to twelve months in age with seven infants currently enrolled. Evacuation cribs are essential for child care facilities to rapidly transport up to 5-6 infants/toddlers to safety during emergencies like fires, featuring large, specialized, easy-rolling wheels and sturdy, often steel-reinforced frames designed to maneuver through doors and down ramps. Space 9 was formerly a space designated for children over one year of age who were mobile and believes this was an oversight when the space transitioned to infant care. You may consider contacting me whenever you consider using a current licensed space for a new age group to discuss age-specific needs for that group prior to transitioning the new age group into the classroom. A lockdown/ shelter-in-place drill was not observed to be recorded between 7/02/2025 and 1/09/2026. It is important for all emergency drills to be completed on time as required for the safety of children enrolled in care. Mrs. Lewis stated that per corporate policy, these drills must take place monthly. She further added she rotates between the different types of drills monthly as well to ensure all types are being practiced, but that she was unsure why none of these were recorded. You may consider creating a monthly email, phone, or calendar reminder to record these drills immediately after they occur. The Criminal Background Check Qualification Letter for one new staff member expired on 1/19/2026. Mrs. Lewis sent the staff member to have her fingerprints taken at the Sheriff’s Department during the visit and stated the staff member would work in a classroom with another staff member who has a valid CBC Qualification Letter until her updated qualification letter has been received. None of the six new staff members’ CBC qualification letters were observed to be linked to the facility’s ABCMS Facility Profile. It is necessary for all staff members to have a current CBC qualification letter and for that letter to be linked to the center’s facility profile in the ABCMS system, as the process of notifying the Division of any new child care providers working who were hired or moved into the child care facility within five business days has changed to include this process. If you need additional assistance in linking these qualification letters to your facility profile please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Consultation Provided During Visit: Each classroom designated for children one and two years of age (four classrooms total) is in need of activities and materials in all centers. Monitor all floor rugs for a tendency to roll up on the edges, creating a potential tripping hazard for children in care. As the Hold Harmless period has ended, and preparations for the new QRIS Modernization process are underway, I have included the link below to DCDEE’s NC Child Care Commission’s QRIS Modernization Plan (QRIS Reform) website link: https://ncchildcare.ncdhhs.gov/Provider/Licensing/Star-Rated-License/QRIS-Modernization • Consider participating in an outreach assessment: https://ncrlap.org/Resources/pages/outreachassessments/ • Visit the NCRLAP website: Get Ready for the 3s (ECERS-3, ITERS-3, FCCERS-3) https://ncrlap.org/Resources/pages/get-ready-for-3s/ Additionally, you may consider reaching out to local partners at Child Care Resource Center and/or Smart Start of Forsyth County. Their teams are working diligently to support programs with training and more detailed information on the ERS-3 at this time. In October, child care consultants began discussing the new rules in Section .3200; Standards for Two through Five Star Rated Licenses during licensing visits. Consultants will review the pathway options, identify facility needs, answer questions, and work with the facility operator to establish an individualized timeline for transition to a new rated license. Mrs. Lewis stated she does not yet know which Pathway the facility will choose or when the facility will begin the Star Rated License this year; she stated future guidance regarding this decision will be provided by Corinne Brylski, Regional Director. I also shared with Mrs. Lewis she can request an announced Technical Assistance visit with me to discuss the QRIS Pathways to the Stars as it relates to the facility. 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-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

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

NC GS 110-90 · Violation

Name of Operation: THE NEST SCHOOL Facility ID: 34001399 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 1/30/2026 Number Present: 95 Completed Date: 1/30/2026 Age: From 0 To 5 Total Minutes: 450 Time In: 09:00 AM Time Out: 04:30 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 with Ashleigh Meyers, Assistant Director. Krista Lewis, Director, was also present for a portion of the visit. Your program currently operates with a 4-Star license effective 10/23/2025. Restrictions include 1st shift care, meets enhanced ratios and children under 2 ½ years old in rooms with direct exits only. The program’s compliance history was 88% 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 were found in compliance. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. The depth of the mulch could not be measured during today's visit due to ice covering the playground; this will be monitored during my next visit. 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, participating in general routines, and eating lunch during the visit. Six new staff members were reported at this program. The files for these staff members were 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 1/04/2026. A fire drill was recorded 1/09/2026. A shelter-in-place drill for the facility was recorded 1/09/2026. The most recent fire inspection was on 5/15/25. I observed a sanitation inspection was last conducted on 10/20/2025 earning a Superior classification. The program does not participate in off-premise or aquatic activities at this time. The following violations were cited during today’s visit: Violation Number Comment Rule 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. An aerosol can of Febreeze, a spray bottle of Clorox, and a spray bottle of glass cleaner labeled Keep Out of Reach of Young Children were observed in an unlocked cabinet in Space 1; the cabinet has a lock on it, but the lock was not functioning properly and did not lock the cabinet. An aerosol can of Febreeze, a spray bottle of Lysol, and a canister of disinfectant wipes labeled Keep Out of Reach of Young Children were observed greater than five feet from the ground, but in an unlocked cabinet in Space 9. In Space 7, a small keychain with hand sanitizer was observed in a staff bag stored less than five feet from the ground and accessible to children. .2820(b) 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. In Space 5A, a diaper cream was not returned to a parent after 1/08; the “valid to” date was recorded as 12/05/2025, and the “valid from” date was recorded as 1/08/2025. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space 6, a classroom designated for children one year of age, a piece of wrapped peppermint candy, greater than three small screws, and other items small enough to be potential choking hazards for children were observed inside an unlatched drawer less than five feet from the ground. .0604(q) 880 Non-mobile children were enrolled and the center did not have a crib or other approved device to safely evacuate the children in an emergency. Evacuation cribs were not observed in Space 9, a room designated for infants ages nine months to twelve months in age with seven infants currently enrolled. .0604(r) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. The safe sleep record for one infant enrolled in Space 9 was not completed for 1/28/2026; a staff member stated the child was present and napped that day. The safe sleep record for another infant enrolled in Space 9 was not observed to have been recorded since 11/10/2025; administration stated the child was present in the following days, and the child was present during today’s visit. .0606(g) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. A safe sleep policy was not observed posted in Space 9. .0606(b) 898 All electrical appliances were not used in accordance with the manufacturers instruction. Appliances with heating elements, such as bottle warmers, crock pots, curling irons, irons, coffee pots, and/or their cords were accessible to preschool-age children. In Space 7, a portable laminator was observed less than five feet from the ground on a child-sized table; the laminator was plugged in and hot to the touch. .0604(e) 1044 Prior to the expiration date of the qualification letter, the child care provider did not complete and submit required forms to complete a criminal background check (a qualification letter is valid for a maximum of five years for the date of issuance). The Criminal Background Check Qualification Letter for one new staff member expired on 1/19/2026. G.S. 110-90.2(b) & .2703(n)&(o) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. None of the six new staff members’ CBC qualification letters were observed to be linked to the facility’s ABCMS Facility Profile. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A lockdown/ shelter-in-place drill was not observed to be recorded between 7/02/2025 and 1/09/2026. .0604(u);.0302(d)(8) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. In Space 9, the name of the topical medication was not observed recorded on the permission to administer topical ointment form for one child enrolled; this name was added to the form during the visit. In Space 2 the permission to administer topical ointment form for one child enrolled did not have a “valid from” date recorded. This date was added to the form during the visit. In Space 9 the permission to administer topical ointment form for one child enrolled did not have a “valid to” and “valid from” date recorded; these dates were added to the form during the visit. In Space 4, the date the topical medication authorization form was signed by a parent was not observed for one child enrolled; this date was recorded during the visit by administration. The diaper creams for two children enrolled in Space 2 and one child enrolled in Space 4 did not have permission to administer forms on file for review. The medication authorization form for one child enrolled in Space 2 with an emergency medication was not observed on file for review. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before 2/13/2026. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation 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. 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 Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical Assistance Provided During Visit: An aerosol can of Febreeze, a spray bottle of Clorox, and a spray bottle of glass cleaner labeled Keep Out of Reach of Young Children were observed in an unlocked cabinet in Space 1; the cabinet has a lock on it, but the lock was not functioning properly and did not lock the cabinet. An aerosol can of Febreeze, a spray bottle of Lysol, and a canister of disinfectant wipes labeled Keep Out of Reach of Young Children were observed greater than five feet from the ground, but in an unlocked cabinet in Space 9. In Space 7, a small keychain with hand sanitizer was observed in a staff bag stored less than five feet from the ground and accessible to children. All items in each of the three spaces were placed into locked storage during the visit. It is essential for the indoor environment to be free of products which can be harmful to children if handled, ingested, or inhaled. Administration stated they were unaware these items were not in locked storage. You may consider monitoring the space designated for child care daily prior to children arriving to ensure there are no items present which could present a safety hazard to children and that all areas containing these items are securely locked. In Space 6, a classroom designated for children one year of age, a piece of wrapped peppermint candy, greater than three small screws, and other items small enough to be potential choking hazards for children were observed inside an unlatched drawer less than five feet from the ground. All of these items were made inaccessible to children during the visit and were placed into locked storage. In Space 7, a portable laminator was observed less than five feet from the ground on a child-sized table; the laminator was plugged in and hot to the touch. This laminator was unplugged and removed from the classroom immediately by Mrs. Lewis. It is imperative for the indoor environment to be a safe place for children to engage with and explore at all times. Potential choking and burning hazards can cause serious harm to young children. You may consider monitoring the space designated for child care daily prior to children arriving to ensure there are either no items present which could present a safety hazard to children, or that these items are properly stored and secured prior to children’s arrival. A safe sleep policy was not observed posted in Space 9; a safe sleep poster was posted in this space by a staff member during the visit. The safe sleep record for one infant enrolled in Space 9 was not completed for 1/28/2026; a staff member stated the child was present and napped that day. The safe sleep record for another infant enrolled in Space 9 was not observed to have been recorded since 11/10/2025; administration stated the child was present in the following days, and the child was present during today’s visit. It is critical for safe sleep practices and requirements to be current and followed at all times. Visually checking on infants while they are sleeping at least every fifteen minutes decreases the risk of a SIDS death occurring. The staff member and administration stated they were unsure why these records were not present for review. You may also consider keeping a small timer in spaces designated for infants which can be set to sound an alert every 15 minutes while infants are sleeping so staff members do not get busy and accidentally overlook recording a safe sleep check. The diaper creams for two children enrolled in Space 2 and one child enrolled in Space 4 did not have permission to administer forms on file for review. The medication authorization form for one child enrolled in Space 2 with an emergency medication was not observed on file for review. It is critical for a medication administration form to be complete, current, and on file prior to any child receiving medication or having topical medication applied for the health and safety of children enrolled. Ms. Myers notified parents of the medications authorization forms needed during the visit. You may consider requiring parents to drop off all medications/ required forms to the office for review by administration before allowing them to be stored in classrooms. Evacuation cribs were not observed in Space 9, a room designated for infants ages nine months to twelve months in age with seven infants currently enrolled. Evacuation cribs are essential for child care facilities to rapidly transport up to 5-6 infants/toddlers to safety during emergencies like fires, featuring large, specialized, easy-rolling wheels and sturdy, often steel-reinforced frames designed to maneuver through doors and down ramps. Space 9 was formerly a space designated for children over one year of age who were mobile and believes this was an oversight when the space transitioned to infant care. You may consider contacting me whenever you consider using a current licensed space for a new age group to discuss age-specific needs for that group prior to transitioning the new age group into the classroom. A lockdown/ shelter-in-place drill was not observed to be recorded between 7/02/2025 and 1/09/2026. It is important for all emergency drills to be completed on time as required for the safety of children enrolled in care. Mrs. Lewis stated that per corporate policy, these drills must take place monthly. She further added she rotates between the different types of drills monthly as well to ensure all types are being practiced, but that she was unsure why none of these were recorded. You may consider creating a monthly email, phone, or calendar reminder to record these drills immediately after they occur. The Criminal Background Check Qualification Letter for one new staff member expired on 1/19/2026. Mrs. Lewis sent the staff member to have her fingerprints taken at the Sheriff’s Department during the visit and stated the staff member would work in a classroom with another staff member who has a valid CBC Qualification Letter until her updated qualification letter has been received. None of the six new staff members’ CBC qualification letters were observed to be linked to the facility’s ABCMS Facility Profile. It is necessary for all staff members to have a current CBC qualification letter and for that letter to be linked to the center’s facility profile in the ABCMS system, as the process of notifying the Division of any new child care providers working who were hired or moved into the child care facility within five business days has changed to include this process. If you need additional assistance in linking these qualification letters to your facility profile please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Consultation Provided During Visit: Each classroom designated for children one and two years of age (four classrooms total) is in need of activities and materials in all centers. Monitor all floor rugs for a tendency to roll up on the edges, creating a potential tripping hazard for children in care. As the Hold Harmless period has ended, and preparations for the new QRIS Modernization process are underway, I have included the link below to DCDEE’s NC Child Care Commission’s QRIS Modernization Plan (QRIS Reform) website link: https://ncchildcare.ncdhhs.gov/Provider/Licensing/Star-Rated-License/QRIS-Modernization • Consider participating in an outreach assessment: https://ncrlap.org/Resources/pages/outreachassessments/ • Visit the NCRLAP website: Get Ready for the 3s (ECERS-3, ITERS-3, FCCERS-3) https://ncrlap.org/Resources/pages/get-ready-for-3s/ Additionally, you may consider reaching out to local partners at Child Care Resource Center and/or Smart Start of Forsyth County. Their teams are working diligently to support programs with training and more detailed information on the ERS-3 at this time. In October, child care consultants began discussing the new rules in Section .3200; Standards for Two through Five Star Rated Licenses during licensing visits. Consultants will review the pathway options, identify facility needs, answer questions, and work with the facility operator to establish an individualized timeline for transition to a new rated license. Mrs. Lewis stated she does not yet know which Pathway the facility will choose or when the facility will begin the Star Rated License this year; she stated future guidance regarding this decision will be provided by Corinne Brylski, Regional Director. I also shared with Mrs. Lewis she can request an announced Technical Assistance visit with me to discuss the QRIS Pathways to the Stars as it relates to the facility. 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-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 .0601 · Violation

Name of Operation: THE NEST SCHOOL Facility ID: 34001399 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 6/9/2025 Number Present: 107 Completed Date: 6/9/2025 Age: From 0 To 5 Total Minutes: 350 Time In: 08:40 AM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for an annual compliance visit. Krista Lewis, Center Director, and Ashleigh Myers, Assistant Director, assisted me with the visit. Your program currently operates with a four-star license, issued August 28, 2024, earning 5 points in the education component, 4 points in the program standards component (meets enhanced ratios) and 1 quality point for the facility offering a staff benefits package and offering and infrastructure of parent involvement. The sanitation inspection was completed 12/23/2024 with a “Superior” classification. The last fire inspection was conducted on 5/15/2025, and your facility was approved for daytime care only. Ms. Lewis provided me a copy of the fire inspection during the visit. The center's compliance history was reviewed with the operator. The program’s compliance history was 83% percent as of 5/05/25. All programs are required to maintain 75% compliance. Upon arrival, the license was posted. Nine classrooms were observed during this visit. All indoor and outdoor areas were observed during the visit. Upon arrival staff/child ratio was observed and recorded on the attached worksheet. Supervision was adequate during the visit. I observed developmentally appropriate materials and activities were available to the children in the classrooms. I observed the children playing in activity areas, participating in general routines, engaging in conversations and activities with their teachers, playing outdoors, eating lunch, and napping during the visit. I observed interactions between staff and children. An allergy list was posted in each classroom and in the kitchen. Storage of hazardous items was monitored and found to be in compliance. Medication storage, emergency medication, action plans and parent authorization to administer medications were monitored. This program does not currently transport children, participate in off-premise activities or participate in aquatic activities. Staff and Training Worksheets were submitted prior to the visit. Due to time restrictions, staff and children’s files were not monitored during today’s visit; a follow-up visit will be conducted to monitor these records. Playground inspections, lockdown/ shelter-in-place drills and fire drill logs were monitored and observed to be in compliance for one year. A fire drill was conducted on 5/06/2025. A lockdown drill was completed on 4/12/2024. A playground inspection was completed on 6/03/2025. The following violations were cited during today's visit: Violation Number Comment Rule 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In Space 6, a classroom designated for children one year of age, greater than four learning centers did not contain sufficient materials accessible for the children’s play. .0510(e)(3) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. The infant feeding plan for one child enrolled in Space 9 was not signed by a parent. .0902(a) 807 A safe indoor and outdoor environment was not provided for the children. In Space 4, a toy shelf was observed to be cracked and chipped on the top right edge and was sharp to the touch. Also in Space 4, a plastic electrical switch plate was observed to be cracked and sharp to the touch. On the playground designated for children of preschool age, one plastic sand table was observed to be cracked and sharp to the touch in greater than three places. 10A NCAC 09 .0601(a) 847 Parent's medication authorization did not include required information. In Space 9, the medication authorization for one child enrolled did not contain the name of the medication. In Space 2, the medication authorization forms for two children enrolled did not contain valid to and from dates. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In Space 4, the medication authorization form for lip balm for one child enrolled expired on 2/05/25. .0803(12) 1329 Application for enrollment did not include all required information. The file for one child enrolled did not contain emergency medical information. .0801(a)(1-7) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. A facility profile for Criminal Background Checks had not been created; hence, staff CBCs were also not yet linked to this profile. G.S. 110-90.2 & .2703(r) 9995 A violation was found for which there is no item number. Child Care Sanitation Rule 15A NCAC 18A .2820 (g) STORAGE states purses and other personal effects belonging to child care center employees shall be kept inaccessible to children and shall be stored in accordance with this Rule, as applicable. The purse belonging to one staff member in Space 8 was observed on the floor of the classroom, accessible to children. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. If additional violations are found in staff and children’s records during the follow-up visit, they will be added to today's visit summary. You must correct the violations found during today's visit immediately and send me documentation verifying compliance on or before 6/23/2025. The following information must be included in your compliance letter: • each violation number, • how you corrected each violation, • what plan will be implemented to prevent each violation from occurring again, • the name of your center, • facility ID number, • date, • title of the person who signs the letter If you state in your Compliance 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. You may email the letter to cara.mckeown@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical Assistance Provided During Visit: In Space 6, a classroom designated for children one year of age, greater than four learning centers did not contain sufficient materials accessible for the children’s play. Ms. Lewis stated a toy order has been placed for additional materials for this classroom. It is important for a sufficient amount of materials to be in every classroom learning center, as this ensures all children have access to a variety of learning activities at all times and decreases the occurrence of challenging behaviors. You may consider keeping an extra supply of materials appropriate for children one and two years of age onsite. You may also consider placing a latch on trash cans in the classrooms designated for these ages or adding trash cans with latches to these rooms, as you stated children sometimes place these toys in the trash cans. Consultation Provided During Visit: Please consider adding monitoring for wasps’ nests at the top of playground structures to your daily playground checks. You may consider adding a reminder to end-of-the-day classroom checks to ensure all safety covers have been placed back into the outlets. All items labeled Keep Out of Reach of Children with additional warnings must be kept in locked storage, even if these items are still sealed and have not been opened. You may consider adding additional learning materials to each classroom designated for children one and two years of age. Thank you for your time and assistance during this visit. At the completion of the visit, this visit summary and enrollment worksheet were provided to you, and you were given the opportunity to ask questions during and following the visit. Contact me at Cara McKeown, Child Care Consultant, (336) 408-4849 or cara.mckeown@dhhs.nc.gov or Pamela Hauser, Licensing Supervisor, pamela.hauser@dhhs.nc.gov if you have questions. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .0803 · Violation

Name of Operation: THE NEST SCHOOL Facility ID: 34001399 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 6/9/2025 Number Present: 107 Completed Date: 6/9/2025 Age: From 0 To 5 Total Minutes: 350 Time In: 08:40 AM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for an annual compliance visit. Krista Lewis, Center Director, and Ashleigh Myers, Assistant Director, assisted me with the visit. Your program currently operates with a four-star license, issued August 28, 2024, earning 5 points in the education component, 4 points in the program standards component (meets enhanced ratios) and 1 quality point for the facility offering a staff benefits package and offering and infrastructure of parent involvement. The sanitation inspection was completed 12/23/2024 with a “Superior” classification. The last fire inspection was conducted on 5/15/2025, and your facility was approved for daytime care only. Ms. Lewis provided me a copy of the fire inspection during the visit. The center's compliance history was reviewed with the operator. The program’s compliance history was 83% percent as of 5/05/25. All programs are required to maintain 75% compliance. Upon arrival, the license was posted. Nine classrooms were observed during this visit. All indoor and outdoor areas were observed during the visit. Upon arrival staff/child ratio was observed and recorded on the attached worksheet. Supervision was adequate during the visit. I observed developmentally appropriate materials and activities were available to the children in the classrooms. I observed the children playing in activity areas, participating in general routines, engaging in conversations and activities with their teachers, playing outdoors, eating lunch, and napping during the visit. I observed interactions between staff and children. An allergy list was posted in each classroom and in the kitchen. Storage of hazardous items was monitored and found to be in compliance. Medication storage, emergency medication, action plans and parent authorization to administer medications were monitored. This program does not currently transport children, participate in off-premise activities or participate in aquatic activities. Staff and Training Worksheets were submitted prior to the visit. Due to time restrictions, staff and children’s files were not monitored during today’s visit; a follow-up visit will be conducted to monitor these records. Playground inspections, lockdown/ shelter-in-place drills and fire drill logs were monitored and observed to be in compliance for one year. A fire drill was conducted on 5/06/2025. A lockdown drill was completed on 4/12/2024. A playground inspection was completed on 6/03/2025. The following violations were cited during today's visit: Violation Number Comment Rule 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In Space 6, a classroom designated for children one year of age, greater than four learning centers did not contain sufficient materials accessible for the children’s play. .0510(e)(3) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. The infant feeding plan for one child enrolled in Space 9 was not signed by a parent. .0902(a) 807 A safe indoor and outdoor environment was not provided for the children. In Space 4, a toy shelf was observed to be cracked and chipped on the top right edge and was sharp to the touch. Also in Space 4, a plastic electrical switch plate was observed to be cracked and sharp to the touch. On the playground designated for children of preschool age, one plastic sand table was observed to be cracked and sharp to the touch in greater than three places. 10A NCAC 09 .0601(a) 847 Parent's medication authorization did not include required information. In Space 9, the medication authorization for one child enrolled did not contain the name of the medication. In Space 2, the medication authorization forms for two children enrolled did not contain valid to and from dates. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In Space 4, the medication authorization form for lip balm for one child enrolled expired on 2/05/25. .0803(12) 1329 Application for enrollment did not include all required information. The file for one child enrolled did not contain emergency medical information. .0801(a)(1-7) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. A facility profile for Criminal Background Checks had not been created; hence, staff CBCs were also not yet linked to this profile. G.S. 110-90.2 & .2703(r) 9995 A violation was found for which there is no item number. Child Care Sanitation Rule 15A NCAC 18A .2820 (g) STORAGE states purses and other personal effects belonging to child care center employees shall be kept inaccessible to children and shall be stored in accordance with this Rule, as applicable. The purse belonging to one staff member in Space 8 was observed on the floor of the classroom, accessible to children. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. If additional violations are found in staff and children’s records during the follow-up visit, they will be added to today's visit summary. You must correct the violations found during today's visit immediately and send me documentation verifying compliance on or before 6/23/2025. The following information must be included in your compliance letter: • each violation number, • how you corrected each violation, • what plan will be implemented to prevent each violation from occurring again, • the name of your center, • facility ID number, • date, • title of the person who signs the letter If you state in your Compliance 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. You may email the letter to cara.mckeown@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical Assistance Provided During Visit: In Space 6, a classroom designated for children one year of age, greater than four learning centers did not contain sufficient materials accessible for the children’s play. Ms. Lewis stated a toy order has been placed for additional materials for this classroom. It is important for a sufficient amount of materials to be in every classroom learning center, as this ensures all children have access to a variety of learning activities at all times and decreases the occurrence of challenging behaviors. You may consider keeping an extra supply of materials appropriate for children one and two years of age onsite. You may also consider placing a latch on trash cans in the classrooms designated for these ages or adding trash cans with latches to these rooms, as you stated children sometimes place these toys in the trash cans. Consultation Provided During Visit: Please consider adding monitoring for wasps’ nests at the top of playground structures to your daily playground checks. You may consider adding a reminder to end-of-the-day classroom checks to ensure all safety covers have been placed back into the outlets. All items labeled Keep Out of Reach of Children with additional warnings must be kept in locked storage, even if these items are still sealed and have not been opened. You may consider adding additional learning materials to each classroom designated for children one and two years of age. Thank you for your time and assistance during this visit. At the completion of the visit, this visit summary and enrollment worksheet were provided to you, and you were given the opportunity to ask questions during and following the visit. Contact me at Cara McKeown, Child Care Consultant, (336) 408-4849 or cara.mckeown@dhhs.nc.gov or Pamela Hauser, Licensing Supervisor, pamela.hauser@dhhs.nc.gov if you have questions. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-90 · Violation

Name of Operation: THE NEST SCHOOL Facility ID: 34001399 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 6/9/2025 Number Present: 107 Completed Date: 6/9/2025 Age: From 0 To 5 Total Minutes: 350 Time In: 08:40 AM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for an annual compliance visit. Krista Lewis, Center Director, and Ashleigh Myers, Assistant Director, assisted me with the visit. Your program currently operates with a four-star license, issued August 28, 2024, earning 5 points in the education component, 4 points in the program standards component (meets enhanced ratios) and 1 quality point for the facility offering a staff benefits package and offering and infrastructure of parent involvement. The sanitation inspection was completed 12/23/2024 with a “Superior” classification. The last fire inspection was conducted on 5/15/2025, and your facility was approved for daytime care only. Ms. Lewis provided me a copy of the fire inspection during the visit. The center's compliance history was reviewed with the operator. The program’s compliance history was 83% percent as of 5/05/25. All programs are required to maintain 75% compliance. Upon arrival, the license was posted. Nine classrooms were observed during this visit. All indoor and outdoor areas were observed during the visit. Upon arrival staff/child ratio was observed and recorded on the attached worksheet. Supervision was adequate during the visit. I observed developmentally appropriate materials and activities were available to the children in the classrooms. I observed the children playing in activity areas, participating in general routines, engaging in conversations and activities with their teachers, playing outdoors, eating lunch, and napping during the visit. I observed interactions between staff and children. An allergy list was posted in each classroom and in the kitchen. Storage of hazardous items was monitored and found to be in compliance. Medication storage, emergency medication, action plans and parent authorization to administer medications were monitored. This program does not currently transport children, participate in off-premise activities or participate in aquatic activities. Staff and Training Worksheets were submitted prior to the visit. Due to time restrictions, staff and children’s files were not monitored during today’s visit; a follow-up visit will be conducted to monitor these records. Playground inspections, lockdown/ shelter-in-place drills and fire drill logs were monitored and observed to be in compliance for one year. A fire drill was conducted on 5/06/2025. A lockdown drill was completed on 4/12/2024. A playground inspection was completed on 6/03/2025. The following violations were cited during today's visit: Violation Number Comment Rule 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In Space 6, a classroom designated for children one year of age, greater than four learning centers did not contain sufficient materials accessible for the children’s play. .0510(e)(3) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. The infant feeding plan for one child enrolled in Space 9 was not signed by a parent. .0902(a) 807 A safe indoor and outdoor environment was not provided for the children. In Space 4, a toy shelf was observed to be cracked and chipped on the top right edge and was sharp to the touch. Also in Space 4, a plastic electrical switch plate was observed to be cracked and sharp to the touch. On the playground designated for children of preschool age, one plastic sand table was observed to be cracked and sharp to the touch in greater than three places. 10A NCAC 09 .0601(a) 847 Parent's medication authorization did not include required information. In Space 9, the medication authorization for one child enrolled did not contain the name of the medication. In Space 2, the medication authorization forms for two children enrolled did not contain valid to and from dates. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In Space 4, the medication authorization form for lip balm for one child enrolled expired on 2/05/25. .0803(12) 1329 Application for enrollment did not include all required information. The file for one child enrolled did not contain emergency medical information. .0801(a)(1-7) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. A facility profile for Criminal Background Checks had not been created; hence, staff CBCs were also not yet linked to this profile. G.S. 110-90.2 & .2703(r) 9995 A violation was found for which there is no item number. Child Care Sanitation Rule 15A NCAC 18A .2820 (g) STORAGE states purses and other personal effects belonging to child care center employees shall be kept inaccessible to children and shall be stored in accordance with this Rule, as applicable. The purse belonging to one staff member in Space 8 was observed on the floor of the classroom, accessible to children. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. If additional violations are found in staff and children’s records during the follow-up visit, they will be added to today's visit summary. You must correct the violations found during today's visit immediately and send me documentation verifying compliance on or before 6/23/2025. The following information must be included in your compliance letter: • each violation number, • how you corrected each violation, • what plan will be implemented to prevent each violation from occurring again, • the name of your center, • facility ID number, • date, • title of the person who signs the letter If you state in your Compliance 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. You may email the letter to cara.mckeown@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical Assistance Provided During Visit: In Space 6, a classroom designated for children one year of age, greater than four learning centers did not contain sufficient materials accessible for the children’s play. Ms. Lewis stated a toy order has been placed for additional materials for this classroom. It is important for a sufficient amount of materials to be in every classroom learning center, as this ensures all children have access to a variety of learning activities at all times and decreases the occurrence of challenging behaviors. You may consider keeping an extra supply of materials appropriate for children one and two years of age onsite. You may also consider placing a latch on trash cans in the classrooms designated for these ages or adding trash cans with latches to these rooms, as you stated children sometimes place these toys in the trash cans. Consultation Provided During Visit: Please consider adding monitoring for wasps’ nests at the top of playground structures to your daily playground checks. You may consider adding a reminder to end-of-the-day classroom checks to ensure all safety covers have been placed back into the outlets. All items labeled Keep Out of Reach of Children with additional warnings must be kept in locked storage, even if these items are still sealed and have not been opened. You may consider adding additional learning materials to each classroom designated for children one and two years of age. Thank you for your time and assistance during this visit. At the completion of the visit, this visit summary and enrollment worksheet were provided to you, and you were given the opportunity to ask questions during and following the visit. Contact me at Cara McKeown, Child Care Consultant, (336) 408-4849 or cara.mckeown@dhhs.nc.gov or Pamela Hauser, Licensing Supervisor, pamela.hauser@dhhs.nc.gov if you have questions. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: THE NEST SCHOOL Facility ID: 34001399 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 6/9/2025 Number Present: 107 Completed Date: 6/9/2025 Age: From 0 To 5 Total Minutes: 350 Time In: 08:40 AM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for an annual compliance visit. Krista Lewis, Center Director, and Ashleigh Myers, Assistant Director, assisted me with the visit. Your program currently operates with a four-star license, issued August 28, 2024, earning 5 points in the education component, 4 points in the program standards component (meets enhanced ratios) and 1 quality point for the facility offering a staff benefits package and offering and infrastructure of parent involvement. The sanitation inspection was completed 12/23/2024 with a “Superior” classification. The last fire inspection was conducted on 5/15/2025, and your facility was approved for daytime care only. Ms. Lewis provided me a copy of the fire inspection during the visit. The center's compliance history was reviewed with the operator. The program’s compliance history was 83% percent as of 5/05/25. All programs are required to maintain 75% compliance. Upon arrival, the license was posted. Nine classrooms were observed during this visit. All indoor and outdoor areas were observed during the visit. Upon arrival staff/child ratio was observed and recorded on the attached worksheet. Supervision was adequate during the visit. I observed developmentally appropriate materials and activities were available to the children in the classrooms. I observed the children playing in activity areas, participating in general routines, engaging in conversations and activities with their teachers, playing outdoors, eating lunch, and napping during the visit. I observed interactions between staff and children. An allergy list was posted in each classroom and in the kitchen. Storage of hazardous items was monitored and found to be in compliance. Medication storage, emergency medication, action plans and parent authorization to administer medications were monitored. This program does not currently transport children, participate in off-premise activities or participate in aquatic activities. Staff and Training Worksheets were submitted prior to the visit. Due to time restrictions, staff and children’s files were not monitored during today’s visit; a follow-up visit will be conducted to monitor these records. Playground inspections, lockdown/ shelter-in-place drills and fire drill logs were monitored and observed to be in compliance for one year. A fire drill was conducted on 5/06/2025. A lockdown drill was completed on 4/12/2024. A playground inspection was completed on 6/03/2025. The following violations were cited during today's visit: Violation Number Comment Rule 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In Space 6, a classroom designated for children one year of age, greater than four learning centers did not contain sufficient materials accessible for the children’s play. .0510(e)(3) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. The infant feeding plan for one child enrolled in Space 9 was not signed by a parent. .0902(a) 807 A safe indoor and outdoor environment was not provided for the children. In Space 4, a toy shelf was observed to be cracked and chipped on the top right edge and was sharp to the touch. Also in Space 4, a plastic electrical switch plate was observed to be cracked and sharp to the touch. On the playground designated for children of preschool age, one plastic sand table was observed to be cracked and sharp to the touch in greater than three places. 10A NCAC 09 .0601(a) 847 Parent's medication authorization did not include required information. In Space 9, the medication authorization for one child enrolled did not contain the name of the medication. In Space 2, the medication authorization forms for two children enrolled did not contain valid to and from dates. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In Space 4, the medication authorization form for lip balm for one child enrolled expired on 2/05/25. .0803(12) 1329 Application for enrollment did not include all required information. The file for one child enrolled did not contain emergency medical information. .0801(a)(1-7) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. A facility profile for Criminal Background Checks had not been created; hence, staff CBCs were also not yet linked to this profile. G.S. 110-90.2 & .2703(r) 9995 A violation was found for which there is no item number. Child Care Sanitation Rule 15A NCAC 18A .2820 (g) STORAGE states purses and other personal effects belonging to child care center employees shall be kept inaccessible to children and shall be stored in accordance with this Rule, as applicable. The purse belonging to one staff member in Space 8 was observed on the floor of the classroom, accessible to children. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. If additional violations are found in staff and children’s records during the follow-up visit, they will be added to today's visit summary. You must correct the violations found during today's visit immediately and send me documentation verifying compliance on or before 6/23/2025. The following information must be included in your compliance letter: • each violation number, • how you corrected each violation, • what plan will be implemented to prevent each violation from occurring again, • the name of your center, • facility ID number, • date, • title of the person who signs the letter If you state in your Compliance 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. You may email the letter to cara.mckeown@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical Assistance Provided During Visit: In Space 6, a classroom designated for children one year of age, greater than four learning centers did not contain sufficient materials accessible for the children’s play. Ms. Lewis stated a toy order has been placed for additional materials for this classroom. It is important for a sufficient amount of materials to be in every classroom learning center, as this ensures all children have access to a variety of learning activities at all times and decreases the occurrence of challenging behaviors. You may consider keeping an extra supply of materials appropriate for children one and two years of age onsite. You may also consider placing a latch on trash cans in the classrooms designated for these ages or adding trash cans with latches to these rooms, as you stated children sometimes place these toys in the trash cans. Consultation Provided During Visit: Please consider adding monitoring for wasps’ nests at the top of playground structures to your daily playground checks. You may consider adding a reminder to end-of-the-day classroom checks to ensure all safety covers have been placed back into the outlets. All items labeled Keep Out of Reach of Children with additional warnings must be kept in locked storage, even if these items are still sealed and have not been opened. You may consider adding additional learning materials to each classroom designated for children one and two years of age. Thank you for your time and assistance during this visit. At the completion of the visit, this visit summary and enrollment worksheet were provided to you, and you were given the opportunity to ask questions during and following the visit. Contact me at Cara McKeown, Child Care Consultant, (336) 408-4849 or cara.mckeown@dhhs.nc.gov or Pamela Hauser, Licensing Supervisor, pamela.hauser@dhhs.nc.gov if you have questions. 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: THE NEST SCHOOL Facility ID: 34001399 Consultant: JACLYN FLOWE Operation Type: Center Case Number: 0525-208A Visit Date: 5/21/2025 Number Present: 121 Completed Date: 5/21/2025 Age: From 0 To 5 Total Minutes: 230 Time In: 11:00 AM Time Out: 02:50 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Announced The purpose of this unannounced visit was to investigate allegations of violations of child care requirements at this child care facility. Krista Lewis, administrator, accompanied me during a walk-through of the facility. During the visit, I discussed the allegations with Ms. Lewis and additional staff members. Limited monitoring of child care requirements occurred during today’s visit. The following violations were observed and/or confirmed 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. On 5/14/25, staff members failed to complete an incident report when a child was injured. On 5/15/25, staff members said they completed an incident report after a child sustained an injury; however, a copy of the incident report was not on file for review. .0802 (e) 902 Each child was not attended to in a nurturing and appropriate manner, or in keeping with the child's developmental needs. On 5/14/25, a staff member spoke to multiple children with a harsh and inappropriate tone of voice, when telling the children to lay down on their nap cots. G.S. 110-91(10) 904 A child was handled in a rough way, including shaking, pushing, shoving, pinching, slapping, biting, kicking, or spanking. On 5/14/25, a staff member moved a 4-year-old child on their nap cot in a rough and inappropriate manner, as a result, the child sustained a bruise on their elbow. .1803(a)(1) 1810 There was a substantiation of child maltreatment. The Division confirmed child maltreatment based on the physical needs of a child. GS 110-105.6(a) Violations must be corrected immediately. Within one week (5/28/25), you must submit documentation of the corrections you made and your plan to maintain compliance with the identified child care requirements to me at jaclyn.flowe@dhhs.nc.gov. You may contact me, Jaclyn Flowe, Investigations Consultant, at phone number 704-495-5363, email at jaclyn.flowe@dhhs.nc.gov, or you may contact Elizabeth Nichols, North Central Investigations Team Supervisor, at elizabeth.nichols@dhhs.nc.gov. Thank you for your time. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

GS 110-105 · Violation

Name of Operation: THE NEST SCHOOL Facility ID: 34001399 Consultant: JACLYN FLOWE Operation Type: Center Case Number: 0525-208A Visit Date: 5/21/2025 Number Present: 121 Completed Date: 5/21/2025 Age: From 0 To 5 Total Minutes: 230 Time In: 11:00 AM Time Out: 02:50 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Announced The purpose of this unannounced visit was to investigate allegations of violations of child care requirements at this child care facility. Krista Lewis, administrator, accompanied me during a walk-through of the facility. During the visit, I discussed the allegations with Ms. Lewis and additional staff members. Limited monitoring of child care requirements occurred during today’s visit. The following violations were observed and/or confirmed 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. On 5/14/25, staff members failed to complete an incident report when a child was injured. On 5/15/25, staff members said they completed an incident report after a child sustained an injury; however, a copy of the incident report was not on file for review. .0802 (e) 902 Each child was not attended to in a nurturing and appropriate manner, or in keeping with the child's developmental needs. On 5/14/25, a staff member spoke to multiple children with a harsh and inappropriate tone of voice, when telling the children to lay down on their nap cots. G.S. 110-91(10) 904 A child was handled in a rough way, including shaking, pushing, shoving, pinching, slapping, biting, kicking, or spanking. On 5/14/25, a staff member moved a 4-year-old child on their nap cot in a rough and inappropriate manner, as a result, the child sustained a bruise on their elbow. .1803(a)(1) 1810 There was a substantiation of child maltreatment. The Division confirmed child maltreatment based on the physical needs of a child. GS 110-105.6(a) Violations must be corrected immediately. Within one week (5/28/25), you must submit documentation of the corrections you made and your plan to maintain compliance with the identified child care requirements to me at jaclyn.flowe@dhhs.nc.gov. You may contact me, Jaclyn Flowe, Investigations Consultant, at phone number 704-495-5363, email at jaclyn.flowe@dhhs.nc.gov, or you may contact Elizabeth Nichols, North Central Investigations Team Supervisor, at elizabeth.nichols@dhhs.nc.gov. Thank you for your time. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0803 · Violation

Name of Operation: THE NEST SCHOOL Facility ID: 34001399 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 1/3/2025 Number Present: 89 Completed Date: 1/3/2025 Age: From 0 To 5 Total Minutes: 315 Time In: 09:30 AM Time Out: 02:45 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 Krista Lewis, Director. Your program currently operates with a 4-Star license effective 8/28/2024. Restrictions include 1st shift care, meets enhanced ratios and children under 2 ½ years old in rooms with direct exits only. The program’s compliance history was 88% 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 were found in 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 playing with toys, playing outside, engaging in conversations and activities with their teachers, participating in general routines, and eating lunch during the visit. Five new staff members were reported at this program. The files for these staff members were 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 12/06/2024. A fire drill was recorded 12/23/2024. A shelter-in-place for the facility was recorded 11/15/2024. The most recent fire inspection was on 6/14/2024. I observed a sanitation inspection was last conducted on 10/23/2024 earning a Superior classification. The program does not participate in off-premise or aquatic activities at this time. The following violations were cited during today’s visit: Violation Number Comment Rule 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. In Space 1, an aerosol canister of room spray was observed in unlocked storage. In Space 4, one bottle of disinfectant spray labeled Keep Out of Reach of Children with additional warnings was observed stored greater than five feet from the ground, but in unlocked storage. Also in Space 4, the emergency medication for one child enrolled was observed to be stored less than five feet from the ground, accessible to children. Greater than ten individual packets of disinfectant wipes labeled Keep Out of Reach of Children with additional warnings were observed in unlocked storage in Space 8. .2820(b) 847 Parent's medication authorization did not include required information. In Space 5, one sunscreen was observed without a medication authorization form. Additionally in Space 5, the name of the diaper cream for one child enrolled was not included on the medication authorization form. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In Space 1 and Space 9, the diaper cream forms for one child enrolled in each classroom were observed to have the recorded length of time the authorization was valid to be expired (each was recorded as valid through 11/2024). In Space 5, two sunscreens were observed for the length of time the authorization was valid to be expired (each was recorded as valid through 11/2024). .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space 2, a space designated for infants, a cabinet was observed to be unlatched and contain greater than two plastic bags and diaper wrappers, presenting a potential choking hazard. On the playground used by children two years old, plastic weed block was observed emerging from a gardening box, presenting a potential choking hazard. .0604(q) 1812 The center did not complete an EPR Plan within four months of completing the EPR in Child Care training and/or the Plan was not completed on a template provided by the Division. A physical copy of the EPR plan was not on file for review, and it had not been updated since 11/142023. .0607(c) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The Ready to Go file was observed to be missing five children’s applications and the contact information for nine staff members. .0607(d)(10) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before 1/17/2025. 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 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. 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 Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical Assistance Provided During Visit: In Space 2, a space designated for infants, a cabinet was observed to be unlatched and contain greater than two plastic bags and diaper wrappers, presenting a potential choking hazard; this cabinet was locked during the visit. On the playground used by children two years old, plastic weed block was observed emerging from a gardening box, presenting a potential choking hazard. A staff member removed this weed block from the gardening box during the visit. A physical copy of the EPR plan was not on file for review, and it had not been updated since 11/142023. It is extremely important that an updated physical copy of the Emergency Preparedness and Response Plan be on file at the facility at all times so if an emergency evacuation occurs and use of technology is not available, staff have access to emergency procedures. Ms. Lewis stated she was unaware this plan had to be updated in the system annually and that she will need to create a new administrator’s account to be able to access the Risk Management Portal. I provided Ms. Lewis the contact information for Amia Eaton, Training and Program Development Consultant, for further information regarding this process. The Ready to Go file was observed to be missing five children’s applications and the contact information for nine staff members. All applications and contact information were added to the Ready to Go file during the visit. In Space 1 and Space 9, the diaper cream forms for one child enrolled in each classroom were observed to have the recorded length of time the authorization was valid to be expired (each was recorded as valid through 11/2024); Ms. Lewis removed these creams from the classroom during the visit. In Space 5, two sunscreens were observed for the length of time the authorization was valid to be expired (each was recorded as valid through 11/2024); each of these sunscreens was removed from the classroom during the visit. Also in Space 5, one sunscreen was observed without a medication authorization form; this sunscreen was removed from the classroom during the visit. Additionally in Space 5, the name of the diaper cream for one child enrolled was not included on the medication authorization form. In Space 1, an aerosol canister of room spray was observed in unlocked storage; this canister was placed into locked storage during the visit. In Space 4, one bottle of disinfectant spray labeled Keep Out of Reach of Children with additional warnings was observed stored greater than five feet from the ground, but in unlocked storage; this spray was placed into locked storage during the visit. Also in Space 4, the emergency medication for one child enrolled was observed to be stored less than five feet from the ground, accessible to children; this medication was placed greater than five feet from the ground during the visit. Greater than ten individual packets of disinfectant wipes labeled Keep Out of Reach of Children with additional warnings were observed in unlocked storage in Space 8; these wipes were placed into locked storage during the visit. Consultation Provided During Visit: The following Child Care Rule was discussed with Ms. Lewis during the visit: • 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (2) • The medication authorization form for prescription medication can be accessed at the following link: https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/M/Medication_Administration_Permission_and_Log.pdf?ver=ZpDmOdNKFFPSHZ98kjLrvA%3d%3d You can access the Risk Management Portal at the following link to update and print your EPR plan: https://rmp.nc.gov/portal/portal.aspx# Please contact Amia M. Eaton, Training and Program Development Consultant at either (919) 814-6365 or Amia.Eaton@dhhs.nc.gov for further guidance regarding creating a new administrator’s account to access this plan. 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 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. Please remove all staff and child information from the Ready to Go file for either staff who are no longer employed, or for children who are no longer enrolled. • You must notify your consultant 30 days prior to changing the ownership status of your facility. At the completion of the visit, this visit summary was 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-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

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

NC GS 110-90 · Violation

Name of Operation: THE NEST SCHOOL Facility ID: 34001399 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 1/3/2025 Number Present: 89 Completed Date: 1/3/2025 Age: From 0 To 5 Total Minutes: 315 Time In: 09:30 AM Time Out: 02:45 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 Krista Lewis, Director. Your program currently operates with a 4-Star license effective 8/28/2024. Restrictions include 1st shift care, meets enhanced ratios and children under 2 ½ years old in rooms with direct exits only. The program’s compliance history was 88% 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 were found in 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 playing with toys, playing outside, engaging in conversations and activities with their teachers, participating in general routines, and eating lunch during the visit. Five new staff members were reported at this program. The files for these staff members were 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 12/06/2024. A fire drill was recorded 12/23/2024. A shelter-in-place for the facility was recorded 11/15/2024. The most recent fire inspection was on 6/14/2024. I observed a sanitation inspection was last conducted on 10/23/2024 earning a Superior classification. The program does not participate in off-premise or aquatic activities at this time. The following violations were cited during today’s visit: Violation Number Comment Rule 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. In Space 1, an aerosol canister of room spray was observed in unlocked storage. In Space 4, one bottle of disinfectant spray labeled Keep Out of Reach of Children with additional warnings was observed stored greater than five feet from the ground, but in unlocked storage. Also in Space 4, the emergency medication for one child enrolled was observed to be stored less than five feet from the ground, accessible to children. Greater than ten individual packets of disinfectant wipes labeled Keep Out of Reach of Children with additional warnings were observed in unlocked storage in Space 8. .2820(b) 847 Parent's medication authorization did not include required information. In Space 5, one sunscreen was observed without a medication authorization form. Additionally in Space 5, the name of the diaper cream for one child enrolled was not included on the medication authorization form. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In Space 1 and Space 9, the diaper cream forms for one child enrolled in each classroom were observed to have the recorded length of time the authorization was valid to be expired (each was recorded as valid through 11/2024). In Space 5, two sunscreens were observed for the length of time the authorization was valid to be expired (each was recorded as valid through 11/2024). .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space 2, a space designated for infants, a cabinet was observed to be unlatched and contain greater than two plastic bags and diaper wrappers, presenting a potential choking hazard. On the playground used by children two years old, plastic weed block was observed emerging from a gardening box, presenting a potential choking hazard. .0604(q) 1812 The center did not complete an EPR Plan within four months of completing the EPR in Child Care training and/or the Plan was not completed on a template provided by the Division. A physical copy of the EPR plan was not on file for review, and it had not been updated since 11/142023. .0607(c) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The Ready to Go file was observed to be missing five children’s applications and the contact information for nine staff members. .0607(d)(10) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before 1/17/2025. 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 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. 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 Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical Assistance Provided During Visit: In Space 2, a space designated for infants, a cabinet was observed to be unlatched and contain greater than two plastic bags and diaper wrappers, presenting a potential choking hazard; this cabinet was locked during the visit. On the playground used by children two years old, plastic weed block was observed emerging from a gardening box, presenting a potential choking hazard. A staff member removed this weed block from the gardening box during the visit. A physical copy of the EPR plan was not on file for review, and it had not been updated since 11/142023. It is extremely important that an updated physical copy of the Emergency Preparedness and Response Plan be on file at the facility at all times so if an emergency evacuation occurs and use of technology is not available, staff have access to emergency procedures. Ms. Lewis stated she was unaware this plan had to be updated in the system annually and that she will need to create a new administrator’s account to be able to access the Risk Management Portal. I provided Ms. Lewis the contact information for Amia Eaton, Training and Program Development Consultant, for further information regarding this process. The Ready to Go file was observed to be missing five children’s applications and the contact information for nine staff members. All applications and contact information were added to the Ready to Go file during the visit. In Space 1 and Space 9, the diaper cream forms for one child enrolled in each classroom were observed to have the recorded length of time the authorization was valid to be expired (each was recorded as valid through 11/2024); Ms. Lewis removed these creams from the classroom during the visit. In Space 5, two sunscreens were observed for the length of time the authorization was valid to be expired (each was recorded as valid through 11/2024); each of these sunscreens was removed from the classroom during the visit. Also in Space 5, one sunscreen was observed without a medication authorization form; this sunscreen was removed from the classroom during the visit. Additionally in Space 5, the name of the diaper cream for one child enrolled was not included on the medication authorization form. In Space 1, an aerosol canister of room spray was observed in unlocked storage; this canister was placed into locked storage during the visit. In Space 4, one bottle of disinfectant spray labeled Keep Out of Reach of Children with additional warnings was observed stored greater than five feet from the ground, but in unlocked storage; this spray was placed into locked storage during the visit. Also in Space 4, the emergency medication for one child enrolled was observed to be stored less than five feet from the ground, accessible to children; this medication was placed greater than five feet from the ground during the visit. Greater than ten individual packets of disinfectant wipes labeled Keep Out of Reach of Children with additional warnings were observed in unlocked storage in Space 8; these wipes were placed into locked storage during the visit. Consultation Provided During Visit: The following Child Care Rule was discussed with Ms. Lewis during the visit: • 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (2) • The medication authorization form for prescription medication can be accessed at the following link: https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/M/Medication_Administration_Permission_and_Log.pdf?ver=ZpDmOdNKFFPSHZ98kjLrvA%3d%3d You can access the Risk Management Portal at the following link to update and print your EPR plan: https://rmp.nc.gov/portal/portal.aspx# Please contact Amia M. Eaton, Training and Program Development Consultant at either (919) 814-6365 or Amia.Eaton@dhhs.nc.gov for further guidance regarding creating a new administrator’s account to access this plan. 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 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. Please remove all staff and child information from the Ready to Go file for either staff who are no longer employed, or for children who are no longer enrolled. • You must notify your consultant 30 days prior to changing the ownership status of your facility. At the completion of the visit, this visit summary was 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-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 .0510 · Violation

Name of Operation: THE NEST SCHOOL Facility ID: 34001399 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 7/11/2024 Number Present: 103 Completed Date: 7/11/2024 Age: From 0 To 5 Total Minutes: 450 Time In: 10:00 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for an annual compliance visit. Krista Lewis, Center Director, assisted me with the visit. Your program currently operates with a four-star license, issued January 15, 2024, earning 5 points in the education component, 4 points in the program standards component (meeting enhanced ratios) and 1 quality point for the facility offering a staff benefits package and offering and infrastructure of parent involvement. The sanitation inspection was completed 9/06/2023 with a “Superior” classification. The last fire inspection was conducted 6/14/2024, and your facility was approved for daytime care only. The Secretary of State website was reviewed on 7/08/2024, and The Nest Schools, Inc. was listed as Current/ Active. The center's compliance history was reviewed with the operator. The program’s compliance history was 93% percent as of 7/08/24. All programs are required to maintain 75% compliance. Upon arrival, the license was posted. Nine classrooms were observed during this visit. All indoor and outdoor areas were observed during the visit. Upon arrival staff/child ratio was observed and recorded on the attached worksheet. Supervision was adequate during the visit. I observed developmentally appropriate materials and activities were available to the children in the classrooms. I observed the children playing in activity areas, participating in general routines, engaging in conversations and activities with their teachers, eating lunch, and napping during the visit. I observed interactions between staff and children. An allergy list was posted in each classroom and in the kitchen. Storage of hazardous items was monitored. Medication storage, emergency medication, action plans and parent authorization to administer medications were monitored. First Aid kits were monitored, and Safe Arrival and Departure procedures were posted at the main entrance of the building. This program does not currently provide transportation for children enrolled or participate in off-premise or aquatic activities. Staff and Training Worksheets were submitted prior to the visit. Due to time restrictions, staff and children’s files were not monitored during today’s visit; a follow-up visit will be conducted to monitor these records. Playground inspections, lockdown/ shelter-in-place drills and fire drill logs were monitored and observed to be in compliance for one year. A fire drill was conducted on 6/24/2024. A lockdown drill was completed on 6/14/2024. A playground inspection was completed on 6/24/2024. The following violations were cited during today's visit: Violation Number Comment Rule 114 A summary of the NC Child Care Law was not given to a parent of every child enrolled in the center. A signed receipt of the Summary of NC Child Care Law was not observed on file for one child enrolled. GS 110-102 428 A current activity plan was not posted for each group of children for reference. An activity plan was not posted in Space 7. GS 110-91(12); .0508(a) 468 When three year old children and older were in care, the materials and equipment in the activity area was not in sufficient quantity to allow at least three children to use the area regardless of whether the children choose the same or different activities. In Space 8, the art center did not contain sufficient materials for three children to use the space at the same time. .0510(d)(1) 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In Spaces 3, 5A, 5B, and 9, the art centers were completely inaccessible to children. In Space 4, the home living center did not contain sufficient materials for three children to use the space at the same time. .0510(e)(3) 508 Special diet or food allergy information was not posted where they can be seen in food preparation and eating areas. An Allergy List was not posted in Space 2. .0901(g) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. The infant feeding plans for two children enrolled (one in Space 1 and one in Space 9) were not signed by a parent or dated upon center receipt. .0902(a) 830 A First Aid information sheet was not posted in a place for referral and/or the information sheet did not include all the required information. The content included in on the First Aid poster posted in each classroom did not include First Aid guidance for scalds, head injuries, poisons, skin wounds, stings, and bites. .0802(h) 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. One bottle of coconut oil skin treatment labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 1. One bottle of hydrogen peroxide labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 3. One bottle of sunscreen labeled Keep Out of Reach of Children with additional warnings was observed hanging inside a bag, less than five feet from the ground in Space 8. .2820(b) 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 prescription diaper cream for one child enrolled was not returned to the parent within 72 hours of the completion of treatment. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space 9, a classroom for children one year of age, two plastic garbage bags were observed in an unlatched drawer located less than five feet from the ground, accessible to children. On the playground designated for children two years of age, two planters were observed to be lined with plastic liner which was observed to be shredding and could present a potential choking hazard. .0604(q) 893 A copy of the safe sleep policy was not given to and/or explained to the parent of each child on or before the first day the infant attended the center. The safe sleep policy for one child enrolled was not signed by a parent. 10A NCAC 09 .0606(c) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. An Emergency Information form was not observed on file for review for one substitute. .0701(a) 1314 Emergency information did not name childs health care professional. The application for one child enrolled did not contain a responsible party’s choice of health care professional. .0802(c)(2) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A lockdown/ shelter-in-place drill was not observed to be documented from August 2023 through February, 2024. .0604(u);.0302(d)(8) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The Ready to Go file did not contain applications for children enrolled, emergency contact information for 102 of the 125 children enrolled, staff contact information, medication authorizations and medical action plans, and copies of blank incident reports. .0607(d)(10) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. A signed notice of the EPR plan location was not observed on file for review for one substitute. .0607(g) 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. The signed Shaken Baby and Abusive Head Trauma Policy for one new employee was not observed on file for review. .0608(d)(1-4) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The diaper cream medication authorization form for one child enrolled in Space 5A was observed without a name of the medication. A diaper cream medication authorization form for one child enrolled in Space 5A was observed without the criteria of when to administer the cream. The sunscreen medication authorization forms for two children enrolled in Space 5A did not contain a parent’s signature. The topical medication authorization forms for two children enrolled in Space 7 were missing criteria for administration and the name of the medication, respectively. The topical medication authorization form for one child enrolled with bug spray wipes was not on file for review. The topical medication authorization forms for three children enrolled in Space 8 were not observed on file for review during the visit (one bug spray, one sunscreen, and one Chapstick). The topical medication authorization forms for five children enrolled in Space 8 did not contain a name of the medication. The diaper cream medication authorization form for one child in Space 9 did not contain a parent’s signature; the same form for another child enrolled in Space 9 did not contain the criteria for how much cream to administer. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. If additional violations are found in staff and children’s records during the follow-up visit, they will be added to today's visit summary. You must correct the violations found during today's visit immediately and send me documentation verifying compliance on or before 7/25/2024. The following information must be included in your compliance letter: • each violation number, • how you corrected each violation, • what plan will be implemented to prevent each violation from occurring again, • the name of your center, • facility ID number, • date, • title of the person who signs the letter If you state in your Compliance 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. You may email the letter to cara.mckeown@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical Assistance Provided During Visit: In Space 9, a classroom for children one year of age, two plastic garbage bags were observed in an unlatched drawer located less than five feet from the ground, accessible to children. Ms. Lewis placed these bags in a cupboard greater than five feet from the ground during the visit. On the playground designated for children two years of age, two planters were observed to be lined with plastic liner which was observed to be shredding and could present a potential choking hazard. Ms. Lewis stated this liner is typically covered by gardening soil, but that the children have been digging inside the planters and removing the soil. It is important for all areas (indoor and outdoor) accessed by children to be safe for exploration. You may consider creating a plan for monitoring the indoor and outdoor learning environments daily, prior to children arriving for care or accessing the outdoor learning environment. One bottle of coconut oil skin treatment labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 1; this item was placed into locked storage during the visit. One bottle of hydrogen peroxide labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 3; this item was placed into locked storage during the visit. One bottle of sunscreen labeled Keep Out of Reach of Children with additional warnings was observed hanging inside a bag, less than five feet from the ground in Space 8; this item was made inaccessible to children during the visit. An Allergy List was not posted in Space 2; this was corrected during the visit. An activity plan was not posted in Space 7; this activity plan was located and posted during the visit. The content included in on the First Aid poster posted in each classroom did not include First Aid guidance for scalds, head injuries, poisons, skin wounds, stings, and bites. The infant feeding plans for two children enrolled (one in Space 1 and one in Space 9) were not signed by a parent or dated upon center receipt. The Ready to Go file did not contain applications for children enrolled, emergency contact information for 102 of the 125 children enrolled, staff contact information, medication authorizations and medical action plans, and copies of blank incident reports. A lockdown/ shelter-in-place drill was not observed to be documented from August 2023 through February, 2024. It is important for all required forms and files to be completed, signed, and/or posted to ensure necessary information is available to staff at all times during the facility’s operating hours for children enrolled. Ms. Lewis stated the facility has been short-staffed, and she has had to serve in a classroom frequently, but that she is updating all information as quickly as possible. You may consider developing a system for monitoring all required posted documentation and emergency information on a routine basis to ensure it is accessible, visible, and current. The diaper cream medication authorization form for one child enrolled in Space 5A was observed without a name of the medication; this was corrected during the visit. The diaper cream medication authorization form for one child enrolled in Space 5A was observed without the criteria of when to administer the cream. The sunscreen medication authorization forms for two children enrolled in Space 5A did not contain a parent’s signature. The topical medication authorization forms for two children enrolled in Space 7 were missing criteria for administration and the name of the medication, respectively. The name for the medication was added to the form during the visit. The topical medication authorization form for one child enrolled with bug spray wipes was not on file for review. The topical medication authorization forms for three children enrolled in Space 8 were not observed on file for review during the visit (one bug spray, one sunscreen, and one Chapstick). The topical medication authorization forms for five children enrolled in Space 8 did not contain a name of the medication; each of these was corrected during the visit. The diaper cream medication authorization form for one child in Space 9 did not contain a parent’s signature; the same form for another child enrolled in Space 9 did not contain the criteria for how much cream to administer. The prescription diaper cream for one child enrolled was not returned to the parent within 72 hours of the completion of treatment; this was corrected during the visit. It is imperative for all required medication documentation to be current and on file for review to ensure the health and safety of each child enrolled. Ms. Lewis and I discussed the idea of the facility considering providing a generic brand of sunscreen and/or bug spray for children during the summer months and pre-filling out each topical medication authorization form for parents (only requiring parental review, child’s name, signature, and date). You may also consider conducting monthly monitoring of all medication documentation for accuracy. In Spaces 3, 5A, 5B, 8, and 9, the art centers were either completely inaccessible to children or did not contain sufficient materials for three children to use the space at the same time. In Space 4, the home living center did not contain sufficient materials for three children to use the space at the same time. All art materials and home living materials were either added or made accessible to children in each classroom during the visit. Consultation Provided During Visit: • The following Child Care Rules were reviewed with Ms. Lewis during the visit: 10A NCAC 09 .0510 ACTIVITY AREAS (d) 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS On February 21, 2024, I emailed you a document regarding required Lead and Asbestos Testing. Ms. Lewis confirmed during today’s visit that the email was received and provided information that testing samples were analyzed on 4/10/2024; no further information was requested. Thank you for your time and assistance during this visit. At the completion of the visit, this visit summary, enrollment worksheet, and monitoring checklist were provided to you. Contact me at Cara McKeown, Child Care Consultant, (336) 408-4849 or cara.mckeown@dhhs.nc.gov or Pamela Hauser, Licensing Supervisor, pamela.hauser@dhhs.nc.gov if you have questions. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .0606 · Violation

Name of Operation: THE NEST SCHOOL Facility ID: 34001399 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 7/11/2024 Number Present: 103 Completed Date: 7/11/2024 Age: From 0 To 5 Total Minutes: 450 Time In: 10:00 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for an annual compliance visit. Krista Lewis, Center Director, assisted me with the visit. Your program currently operates with a four-star license, issued January 15, 2024, earning 5 points in the education component, 4 points in the program standards component (meeting enhanced ratios) and 1 quality point for the facility offering a staff benefits package and offering and infrastructure of parent involvement. The sanitation inspection was completed 9/06/2023 with a “Superior” classification. The last fire inspection was conducted 6/14/2024, and your facility was approved for daytime care only. The Secretary of State website was reviewed on 7/08/2024, and The Nest Schools, Inc. was listed as Current/ Active. The center's compliance history was reviewed with the operator. The program’s compliance history was 93% percent as of 7/08/24. All programs are required to maintain 75% compliance. Upon arrival, the license was posted. Nine classrooms were observed during this visit. All indoor and outdoor areas were observed during the visit. Upon arrival staff/child ratio was observed and recorded on the attached worksheet. Supervision was adequate during the visit. I observed developmentally appropriate materials and activities were available to the children in the classrooms. I observed the children playing in activity areas, participating in general routines, engaging in conversations and activities with their teachers, eating lunch, and napping during the visit. I observed interactions between staff and children. An allergy list was posted in each classroom and in the kitchen. Storage of hazardous items was monitored. Medication storage, emergency medication, action plans and parent authorization to administer medications were monitored. First Aid kits were monitored, and Safe Arrival and Departure procedures were posted at the main entrance of the building. This program does not currently provide transportation for children enrolled or participate in off-premise or aquatic activities. Staff and Training Worksheets were submitted prior to the visit. Due to time restrictions, staff and children’s files were not monitored during today’s visit; a follow-up visit will be conducted to monitor these records. Playground inspections, lockdown/ shelter-in-place drills and fire drill logs were monitored and observed to be in compliance for one year. A fire drill was conducted on 6/24/2024. A lockdown drill was completed on 6/14/2024. A playground inspection was completed on 6/24/2024. The following violations were cited during today's visit: Violation Number Comment Rule 114 A summary of the NC Child Care Law was not given to a parent of every child enrolled in the center. A signed receipt of the Summary of NC Child Care Law was not observed on file for one child enrolled. GS 110-102 428 A current activity plan was not posted for each group of children for reference. An activity plan was not posted in Space 7. GS 110-91(12); .0508(a) 468 When three year old children and older were in care, the materials and equipment in the activity area was not in sufficient quantity to allow at least three children to use the area regardless of whether the children choose the same or different activities. In Space 8, the art center did not contain sufficient materials for three children to use the space at the same time. .0510(d)(1) 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In Spaces 3, 5A, 5B, and 9, the art centers were completely inaccessible to children. In Space 4, the home living center did not contain sufficient materials for three children to use the space at the same time. .0510(e)(3) 508 Special diet or food allergy information was not posted where they can be seen in food preparation and eating areas. An Allergy List was not posted in Space 2. .0901(g) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. The infant feeding plans for two children enrolled (one in Space 1 and one in Space 9) were not signed by a parent or dated upon center receipt. .0902(a) 830 A First Aid information sheet was not posted in a place for referral and/or the information sheet did not include all the required information. The content included in on the First Aid poster posted in each classroom did not include First Aid guidance for scalds, head injuries, poisons, skin wounds, stings, and bites. .0802(h) 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. One bottle of coconut oil skin treatment labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 1. One bottle of hydrogen peroxide labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 3. One bottle of sunscreen labeled Keep Out of Reach of Children with additional warnings was observed hanging inside a bag, less than five feet from the ground in Space 8. .2820(b) 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 prescription diaper cream for one child enrolled was not returned to the parent within 72 hours of the completion of treatment. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space 9, a classroom for children one year of age, two plastic garbage bags were observed in an unlatched drawer located less than five feet from the ground, accessible to children. On the playground designated for children two years of age, two planters were observed to be lined with plastic liner which was observed to be shredding and could present a potential choking hazard. .0604(q) 893 A copy of the safe sleep policy was not given to and/or explained to the parent of each child on or before the first day the infant attended the center. The safe sleep policy for one child enrolled was not signed by a parent. 10A NCAC 09 .0606(c) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. An Emergency Information form was not observed on file for review for one substitute. .0701(a) 1314 Emergency information did not name childs health care professional. The application for one child enrolled did not contain a responsible party’s choice of health care professional. .0802(c)(2) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A lockdown/ shelter-in-place drill was not observed to be documented from August 2023 through February, 2024. .0604(u);.0302(d)(8) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The Ready to Go file did not contain applications for children enrolled, emergency contact information for 102 of the 125 children enrolled, staff contact information, medication authorizations and medical action plans, and copies of blank incident reports. .0607(d)(10) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. A signed notice of the EPR plan location was not observed on file for review for one substitute. .0607(g) 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. The signed Shaken Baby and Abusive Head Trauma Policy for one new employee was not observed on file for review. .0608(d)(1-4) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The diaper cream medication authorization form for one child enrolled in Space 5A was observed without a name of the medication. A diaper cream medication authorization form for one child enrolled in Space 5A was observed without the criteria of when to administer the cream. The sunscreen medication authorization forms for two children enrolled in Space 5A did not contain a parent’s signature. The topical medication authorization forms for two children enrolled in Space 7 were missing criteria for administration and the name of the medication, respectively. The topical medication authorization form for one child enrolled with bug spray wipes was not on file for review. The topical medication authorization forms for three children enrolled in Space 8 were not observed on file for review during the visit (one bug spray, one sunscreen, and one Chapstick). The topical medication authorization forms for five children enrolled in Space 8 did not contain a name of the medication. The diaper cream medication authorization form for one child in Space 9 did not contain a parent’s signature; the same form for another child enrolled in Space 9 did not contain the criteria for how much cream to administer. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. If additional violations are found in staff and children’s records during the follow-up visit, they will be added to today's visit summary. You must correct the violations found during today's visit immediately and send me documentation verifying compliance on or before 7/25/2024. The following information must be included in your compliance letter: • each violation number, • how you corrected each violation, • what plan will be implemented to prevent each violation from occurring again, • the name of your center, • facility ID number, • date, • title of the person who signs the letter If you state in your Compliance 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. You may email the letter to cara.mckeown@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical Assistance Provided During Visit: In Space 9, a classroom for children one year of age, two plastic garbage bags were observed in an unlatched drawer located less than five feet from the ground, accessible to children. Ms. Lewis placed these bags in a cupboard greater than five feet from the ground during the visit. On the playground designated for children two years of age, two planters were observed to be lined with plastic liner which was observed to be shredding and could present a potential choking hazard. Ms. Lewis stated this liner is typically covered by gardening soil, but that the children have been digging inside the planters and removing the soil. It is important for all areas (indoor and outdoor) accessed by children to be safe for exploration. You may consider creating a plan for monitoring the indoor and outdoor learning environments daily, prior to children arriving for care or accessing the outdoor learning environment. One bottle of coconut oil skin treatment labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 1; this item was placed into locked storage during the visit. One bottle of hydrogen peroxide labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 3; this item was placed into locked storage during the visit. One bottle of sunscreen labeled Keep Out of Reach of Children with additional warnings was observed hanging inside a bag, less than five feet from the ground in Space 8; this item was made inaccessible to children during the visit. An Allergy List was not posted in Space 2; this was corrected during the visit. An activity plan was not posted in Space 7; this activity plan was located and posted during the visit. The content included in on the First Aid poster posted in each classroom did not include First Aid guidance for scalds, head injuries, poisons, skin wounds, stings, and bites. The infant feeding plans for two children enrolled (one in Space 1 and one in Space 9) were not signed by a parent or dated upon center receipt. The Ready to Go file did not contain applications for children enrolled, emergency contact information for 102 of the 125 children enrolled, staff contact information, medication authorizations and medical action plans, and copies of blank incident reports. A lockdown/ shelter-in-place drill was not observed to be documented from August 2023 through February, 2024. It is important for all required forms and files to be completed, signed, and/or posted to ensure necessary information is available to staff at all times during the facility’s operating hours for children enrolled. Ms. Lewis stated the facility has been short-staffed, and she has had to serve in a classroom frequently, but that she is updating all information as quickly as possible. You may consider developing a system for monitoring all required posted documentation and emergency information on a routine basis to ensure it is accessible, visible, and current. The diaper cream medication authorization form for one child enrolled in Space 5A was observed without a name of the medication; this was corrected during the visit. The diaper cream medication authorization form for one child enrolled in Space 5A was observed without the criteria of when to administer the cream. The sunscreen medication authorization forms for two children enrolled in Space 5A did not contain a parent’s signature. The topical medication authorization forms for two children enrolled in Space 7 were missing criteria for administration and the name of the medication, respectively. The name for the medication was added to the form during the visit. The topical medication authorization form for one child enrolled with bug spray wipes was not on file for review. The topical medication authorization forms for three children enrolled in Space 8 were not observed on file for review during the visit (one bug spray, one sunscreen, and one Chapstick). The topical medication authorization forms for five children enrolled in Space 8 did not contain a name of the medication; each of these was corrected during the visit. The diaper cream medication authorization form for one child in Space 9 did not contain a parent’s signature; the same form for another child enrolled in Space 9 did not contain the criteria for how much cream to administer. The prescription diaper cream for one child enrolled was not returned to the parent within 72 hours of the completion of treatment; this was corrected during the visit. It is imperative for all required medication documentation to be current and on file for review to ensure the health and safety of each child enrolled. Ms. Lewis and I discussed the idea of the facility considering providing a generic brand of sunscreen and/or bug spray for children during the summer months and pre-filling out each topical medication authorization form for parents (only requiring parental review, child’s name, signature, and date). You may also consider conducting monthly monitoring of all medication documentation for accuracy. In Spaces 3, 5A, 5B, 8, and 9, the art centers were either completely inaccessible to children or did not contain sufficient materials for three children to use the space at the same time. In Space 4, the home living center did not contain sufficient materials for three children to use the space at the same time. All art materials and home living materials were either added or made accessible to children in each classroom during the visit. Consultation Provided During Visit: • The following Child Care Rules were reviewed with Ms. Lewis during the visit: 10A NCAC 09 .0510 ACTIVITY AREAS (d) 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS On February 21, 2024, I emailed you a document regarding required Lead and Asbestos Testing. Ms. Lewis confirmed during today’s visit that the email was received and provided information that testing samples were analyzed on 4/10/2024; no further information was requested. Thank you for your time and assistance during this visit. At the completion of the visit, this visit summary, enrollment worksheet, and monitoring checklist were provided to you. Contact me at Cara McKeown, Child Care Consultant, (336) 408-4849 or cara.mckeown@dhhs.nc.gov or Pamela Hauser, Licensing Supervisor, pamela.hauser@dhhs.nc.gov if you have questions. 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: THE NEST SCHOOL Facility ID: 34001399 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 7/11/2024 Number Present: 103 Completed Date: 7/11/2024 Age: From 0 To 5 Total Minutes: 450 Time In: 10:00 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for an annual compliance visit. Krista Lewis, Center Director, assisted me with the visit. Your program currently operates with a four-star license, issued January 15, 2024, earning 5 points in the education component, 4 points in the program standards component (meeting enhanced ratios) and 1 quality point for the facility offering a staff benefits package and offering and infrastructure of parent involvement. The sanitation inspection was completed 9/06/2023 with a “Superior” classification. The last fire inspection was conducted 6/14/2024, and your facility was approved for daytime care only. The Secretary of State website was reviewed on 7/08/2024, and The Nest Schools, Inc. was listed as Current/ Active. The center's compliance history was reviewed with the operator. The program’s compliance history was 93% percent as of 7/08/24. All programs are required to maintain 75% compliance. Upon arrival, the license was posted. Nine classrooms were observed during this visit. All indoor and outdoor areas were observed during the visit. Upon arrival staff/child ratio was observed and recorded on the attached worksheet. Supervision was adequate during the visit. I observed developmentally appropriate materials and activities were available to the children in the classrooms. I observed the children playing in activity areas, participating in general routines, engaging in conversations and activities with their teachers, eating lunch, and napping during the visit. I observed interactions between staff and children. An allergy list was posted in each classroom and in the kitchen. Storage of hazardous items was monitored. Medication storage, emergency medication, action plans and parent authorization to administer medications were monitored. First Aid kits were monitored, and Safe Arrival and Departure procedures were posted at the main entrance of the building. This program does not currently provide transportation for children enrolled or participate in off-premise or aquatic activities. Staff and Training Worksheets were submitted prior to the visit. Due to time restrictions, staff and children’s files were not monitored during today’s visit; a follow-up visit will be conducted to monitor these records. Playground inspections, lockdown/ shelter-in-place drills and fire drill logs were monitored and observed to be in compliance for one year. A fire drill was conducted on 6/24/2024. A lockdown drill was completed on 6/14/2024. A playground inspection was completed on 6/24/2024. The following violations were cited during today's visit: Violation Number Comment Rule 114 A summary of the NC Child Care Law was not given to a parent of every child enrolled in the center. A signed receipt of the Summary of NC Child Care Law was not observed on file for one child enrolled. GS 110-102 428 A current activity plan was not posted for each group of children for reference. An activity plan was not posted in Space 7. GS 110-91(12); .0508(a) 468 When three year old children and older were in care, the materials and equipment in the activity area was not in sufficient quantity to allow at least three children to use the area regardless of whether the children choose the same or different activities. In Space 8, the art center did not contain sufficient materials for three children to use the space at the same time. .0510(d)(1) 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In Spaces 3, 5A, 5B, and 9, the art centers were completely inaccessible to children. In Space 4, the home living center did not contain sufficient materials for three children to use the space at the same time. .0510(e)(3) 508 Special diet or food allergy information was not posted where they can be seen in food preparation and eating areas. An Allergy List was not posted in Space 2. .0901(g) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. The infant feeding plans for two children enrolled (one in Space 1 and one in Space 9) were not signed by a parent or dated upon center receipt. .0902(a) 830 A First Aid information sheet was not posted in a place for referral and/or the information sheet did not include all the required information. The content included in on the First Aid poster posted in each classroom did not include First Aid guidance for scalds, head injuries, poisons, skin wounds, stings, and bites. .0802(h) 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. One bottle of coconut oil skin treatment labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 1. One bottle of hydrogen peroxide labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 3. One bottle of sunscreen labeled Keep Out of Reach of Children with additional warnings was observed hanging inside a bag, less than five feet from the ground in Space 8. .2820(b) 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 prescription diaper cream for one child enrolled was not returned to the parent within 72 hours of the completion of treatment. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space 9, a classroom for children one year of age, two plastic garbage bags were observed in an unlatched drawer located less than five feet from the ground, accessible to children. On the playground designated for children two years of age, two planters were observed to be lined with plastic liner which was observed to be shredding and could present a potential choking hazard. .0604(q) 893 A copy of the safe sleep policy was not given to and/or explained to the parent of each child on or before the first day the infant attended the center. The safe sleep policy for one child enrolled was not signed by a parent. 10A NCAC 09 .0606(c) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. An Emergency Information form was not observed on file for review for one substitute. .0701(a) 1314 Emergency information did not name childs health care professional. The application for one child enrolled did not contain a responsible party’s choice of health care professional. .0802(c)(2) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A lockdown/ shelter-in-place drill was not observed to be documented from August 2023 through February, 2024. .0604(u);.0302(d)(8) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The Ready to Go file did not contain applications for children enrolled, emergency contact information for 102 of the 125 children enrolled, staff contact information, medication authorizations and medical action plans, and copies of blank incident reports. .0607(d)(10) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. A signed notice of the EPR plan location was not observed on file for review for one substitute. .0607(g) 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. The signed Shaken Baby and Abusive Head Trauma Policy for one new employee was not observed on file for review. .0608(d)(1-4) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The diaper cream medication authorization form for one child enrolled in Space 5A was observed without a name of the medication. A diaper cream medication authorization form for one child enrolled in Space 5A was observed without the criteria of when to administer the cream. The sunscreen medication authorization forms for two children enrolled in Space 5A did not contain a parent’s signature. The topical medication authorization forms for two children enrolled in Space 7 were missing criteria for administration and the name of the medication, respectively. The topical medication authorization form for one child enrolled with bug spray wipes was not on file for review. The topical medication authorization forms for three children enrolled in Space 8 were not observed on file for review during the visit (one bug spray, one sunscreen, and one Chapstick). The topical medication authorization forms for five children enrolled in Space 8 did not contain a name of the medication. The diaper cream medication authorization form for one child in Space 9 did not contain a parent’s signature; the same form for another child enrolled in Space 9 did not contain the criteria for how much cream to administer. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. If additional violations are found in staff and children’s records during the follow-up visit, they will be added to today's visit summary. You must correct the violations found during today's visit immediately and send me documentation verifying compliance on or before 7/25/2024. The following information must be included in your compliance letter: • each violation number, • how you corrected each violation, • what plan will be implemented to prevent each violation from occurring again, • the name of your center, • facility ID number, • date, • title of the person who signs the letter If you state in your Compliance 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. You may email the letter to cara.mckeown@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical Assistance Provided During Visit: In Space 9, a classroom for children one year of age, two plastic garbage bags were observed in an unlatched drawer located less than five feet from the ground, accessible to children. Ms. Lewis placed these bags in a cupboard greater than five feet from the ground during the visit. On the playground designated for children two years of age, two planters were observed to be lined with plastic liner which was observed to be shredding and could present a potential choking hazard. Ms. Lewis stated this liner is typically covered by gardening soil, but that the children have been digging inside the planters and removing the soil. It is important for all areas (indoor and outdoor) accessed by children to be safe for exploration. You may consider creating a plan for monitoring the indoor and outdoor learning environments daily, prior to children arriving for care or accessing the outdoor learning environment. One bottle of coconut oil skin treatment labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 1; this item was placed into locked storage during the visit. One bottle of hydrogen peroxide labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 3; this item was placed into locked storage during the visit. One bottle of sunscreen labeled Keep Out of Reach of Children with additional warnings was observed hanging inside a bag, less than five feet from the ground in Space 8; this item was made inaccessible to children during the visit. An Allergy List was not posted in Space 2; this was corrected during the visit. An activity plan was not posted in Space 7; this activity plan was located and posted during the visit. The content included in on the First Aid poster posted in each classroom did not include First Aid guidance for scalds, head injuries, poisons, skin wounds, stings, and bites. The infant feeding plans for two children enrolled (one in Space 1 and one in Space 9) were not signed by a parent or dated upon center receipt. The Ready to Go file did not contain applications for children enrolled, emergency contact information for 102 of the 125 children enrolled, staff contact information, medication authorizations and medical action plans, and copies of blank incident reports. A lockdown/ shelter-in-place drill was not observed to be documented from August 2023 through February, 2024. It is important for all required forms and files to be completed, signed, and/or posted to ensure necessary information is available to staff at all times during the facility’s operating hours for children enrolled. Ms. Lewis stated the facility has been short-staffed, and she has had to serve in a classroom frequently, but that she is updating all information as quickly as possible. You may consider developing a system for monitoring all required posted documentation and emergency information on a routine basis to ensure it is accessible, visible, and current. The diaper cream medication authorization form for one child enrolled in Space 5A was observed without a name of the medication; this was corrected during the visit. The diaper cream medication authorization form for one child enrolled in Space 5A was observed without the criteria of when to administer the cream. The sunscreen medication authorization forms for two children enrolled in Space 5A did not contain a parent’s signature. The topical medication authorization forms for two children enrolled in Space 7 were missing criteria for administration and the name of the medication, respectively. The name for the medication was added to the form during the visit. The topical medication authorization form for one child enrolled with bug spray wipes was not on file for review. The topical medication authorization forms for three children enrolled in Space 8 were not observed on file for review during the visit (one bug spray, one sunscreen, and one Chapstick). The topical medication authorization forms for five children enrolled in Space 8 did not contain a name of the medication; each of these was corrected during the visit. The diaper cream medication authorization form for one child in Space 9 did not contain a parent’s signature; the same form for another child enrolled in Space 9 did not contain the criteria for how much cream to administer. The prescription diaper cream for one child enrolled was not returned to the parent within 72 hours of the completion of treatment; this was corrected during the visit. It is imperative for all required medication documentation to be current and on file for review to ensure the health and safety of each child enrolled. Ms. Lewis and I discussed the idea of the facility considering providing a generic brand of sunscreen and/or bug spray for children during the summer months and pre-filling out each topical medication authorization form for parents (only requiring parental review, child’s name, signature, and date). You may also consider conducting monthly monitoring of all medication documentation for accuracy. In Spaces 3, 5A, 5B, 8, and 9, the art centers were either completely inaccessible to children or did not contain sufficient materials for three children to use the space at the same time. In Space 4, the home living center did not contain sufficient materials for three children to use the space at the same time. All art materials and home living materials were either added or made accessible to children in each classroom during the visit. Consultation Provided During Visit: • The following Child Care Rules were reviewed with Ms. Lewis during the visit: 10A NCAC 09 .0510 ACTIVITY AREAS (d) 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS On February 21, 2024, I emailed you a document regarding required Lead and Asbestos Testing. Ms. Lewis confirmed during today’s visit that the email was received and provided information that testing samples were analyzed on 4/10/2024; no further information was requested. Thank you for your time and assistance during this visit. At the completion of the visit, this visit summary, enrollment worksheet, and monitoring checklist were provided to you. Contact me at Cara McKeown, Child Care Consultant, (336) 408-4849 or cara.mckeown@dhhs.nc.gov or Pamela Hauser, Licensing Supervisor, pamela.hauser@dhhs.nc.gov if you have questions. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS 110-102 · Violation

Name of Operation: THE NEST SCHOOL Facility ID: 34001399 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 7/11/2024 Number Present: 103 Completed Date: 7/11/2024 Age: From 0 To 5 Total Minutes: 450 Time In: 10:00 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for an annual compliance visit. Krista Lewis, Center Director, assisted me with the visit. Your program currently operates with a four-star license, issued January 15, 2024, earning 5 points in the education component, 4 points in the program standards component (meeting enhanced ratios) and 1 quality point for the facility offering a staff benefits package and offering and infrastructure of parent involvement. The sanitation inspection was completed 9/06/2023 with a “Superior” classification. The last fire inspection was conducted 6/14/2024, and your facility was approved for daytime care only. The Secretary of State website was reviewed on 7/08/2024, and The Nest Schools, Inc. was listed as Current/ Active. The center's compliance history was reviewed with the operator. The program’s compliance history was 93% percent as of 7/08/24. All programs are required to maintain 75% compliance. Upon arrival, the license was posted. Nine classrooms were observed during this visit. All indoor and outdoor areas were observed during the visit. Upon arrival staff/child ratio was observed and recorded on the attached worksheet. Supervision was adequate during the visit. I observed developmentally appropriate materials and activities were available to the children in the classrooms. I observed the children playing in activity areas, participating in general routines, engaging in conversations and activities with their teachers, eating lunch, and napping during the visit. I observed interactions between staff and children. An allergy list was posted in each classroom and in the kitchen. Storage of hazardous items was monitored. Medication storage, emergency medication, action plans and parent authorization to administer medications were monitored. First Aid kits were monitored, and Safe Arrival and Departure procedures were posted at the main entrance of the building. This program does not currently provide transportation for children enrolled or participate in off-premise or aquatic activities. Staff and Training Worksheets were submitted prior to the visit. Due to time restrictions, staff and children’s files were not monitored during today’s visit; a follow-up visit will be conducted to monitor these records. Playground inspections, lockdown/ shelter-in-place drills and fire drill logs were monitored and observed to be in compliance for one year. A fire drill was conducted on 6/24/2024. A lockdown drill was completed on 6/14/2024. A playground inspection was completed on 6/24/2024. The following violations were cited during today's visit: Violation Number Comment Rule 114 A summary of the NC Child Care Law was not given to a parent of every child enrolled in the center. A signed receipt of the Summary of NC Child Care Law was not observed on file for one child enrolled. GS 110-102 428 A current activity plan was not posted for each group of children for reference. An activity plan was not posted in Space 7. GS 110-91(12); .0508(a) 468 When three year old children and older were in care, the materials and equipment in the activity area was not in sufficient quantity to allow at least three children to use the area regardless of whether the children choose the same or different activities. In Space 8, the art center did not contain sufficient materials for three children to use the space at the same time. .0510(d)(1) 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In Spaces 3, 5A, 5B, and 9, the art centers were completely inaccessible to children. In Space 4, the home living center did not contain sufficient materials for three children to use the space at the same time. .0510(e)(3) 508 Special diet or food allergy information was not posted where they can be seen in food preparation and eating areas. An Allergy List was not posted in Space 2. .0901(g) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. The infant feeding plans for two children enrolled (one in Space 1 and one in Space 9) were not signed by a parent or dated upon center receipt. .0902(a) 830 A First Aid information sheet was not posted in a place for referral and/or the information sheet did not include all the required information. The content included in on the First Aid poster posted in each classroom did not include First Aid guidance for scalds, head injuries, poisons, skin wounds, stings, and bites. .0802(h) 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. One bottle of coconut oil skin treatment labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 1. One bottle of hydrogen peroxide labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 3. One bottle of sunscreen labeled Keep Out of Reach of Children with additional warnings was observed hanging inside a bag, less than five feet from the ground in Space 8. .2820(b) 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 prescription diaper cream for one child enrolled was not returned to the parent within 72 hours of the completion of treatment. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space 9, a classroom for children one year of age, two plastic garbage bags were observed in an unlatched drawer located less than five feet from the ground, accessible to children. On the playground designated for children two years of age, two planters were observed to be lined with plastic liner which was observed to be shredding and could present a potential choking hazard. .0604(q) 893 A copy of the safe sleep policy was not given to and/or explained to the parent of each child on or before the first day the infant attended the center. The safe sleep policy for one child enrolled was not signed by a parent. 10A NCAC 09 .0606(c) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. An Emergency Information form was not observed on file for review for one substitute. .0701(a) 1314 Emergency information did not name childs health care professional. The application for one child enrolled did not contain a responsible party’s choice of health care professional. .0802(c)(2) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A lockdown/ shelter-in-place drill was not observed to be documented from August 2023 through February, 2024. .0604(u);.0302(d)(8) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The Ready to Go file did not contain applications for children enrolled, emergency contact information for 102 of the 125 children enrolled, staff contact information, medication authorizations and medical action plans, and copies of blank incident reports. .0607(d)(10) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. A signed notice of the EPR plan location was not observed on file for review for one substitute. .0607(g) 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. The signed Shaken Baby and Abusive Head Trauma Policy for one new employee was not observed on file for review. .0608(d)(1-4) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The diaper cream medication authorization form for one child enrolled in Space 5A was observed without a name of the medication. A diaper cream medication authorization form for one child enrolled in Space 5A was observed without the criteria of when to administer the cream. The sunscreen medication authorization forms for two children enrolled in Space 5A did not contain a parent’s signature. The topical medication authorization forms for two children enrolled in Space 7 were missing criteria for administration and the name of the medication, respectively. The topical medication authorization form for one child enrolled with bug spray wipes was not on file for review. The topical medication authorization forms for three children enrolled in Space 8 were not observed on file for review during the visit (one bug spray, one sunscreen, and one Chapstick). The topical medication authorization forms for five children enrolled in Space 8 did not contain a name of the medication. The diaper cream medication authorization form for one child in Space 9 did not contain a parent’s signature; the same form for another child enrolled in Space 9 did not contain the criteria for how much cream to administer. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. If additional violations are found in staff and children’s records during the follow-up visit, they will be added to today's visit summary. You must correct the violations found during today's visit immediately and send me documentation verifying compliance on or before 7/25/2024. The following information must be included in your compliance letter: • each violation number, • how you corrected each violation, • what plan will be implemented to prevent each violation from occurring again, • the name of your center, • facility ID number, • date, • title of the person who signs the letter If you state in your Compliance 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. You may email the letter to cara.mckeown@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical Assistance Provided During Visit: In Space 9, a classroom for children one year of age, two plastic garbage bags were observed in an unlatched drawer located less than five feet from the ground, accessible to children. Ms. Lewis placed these bags in a cupboard greater than five feet from the ground during the visit. On the playground designated for children two years of age, two planters were observed to be lined with plastic liner which was observed to be shredding and could present a potential choking hazard. Ms. Lewis stated this liner is typically covered by gardening soil, but that the children have been digging inside the planters and removing the soil. It is important for all areas (indoor and outdoor) accessed by children to be safe for exploration. You may consider creating a plan for monitoring the indoor and outdoor learning environments daily, prior to children arriving for care or accessing the outdoor learning environment. One bottle of coconut oil skin treatment labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 1; this item was placed into locked storage during the visit. One bottle of hydrogen peroxide labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 3; this item was placed into locked storage during the visit. One bottle of sunscreen labeled Keep Out of Reach of Children with additional warnings was observed hanging inside a bag, less than five feet from the ground in Space 8; this item was made inaccessible to children during the visit. An Allergy List was not posted in Space 2; this was corrected during the visit. An activity plan was not posted in Space 7; this activity plan was located and posted during the visit. The content included in on the First Aid poster posted in each classroom did not include First Aid guidance for scalds, head injuries, poisons, skin wounds, stings, and bites. The infant feeding plans for two children enrolled (one in Space 1 and one in Space 9) were not signed by a parent or dated upon center receipt. The Ready to Go file did not contain applications for children enrolled, emergency contact information for 102 of the 125 children enrolled, staff contact information, medication authorizations and medical action plans, and copies of blank incident reports. A lockdown/ shelter-in-place drill was not observed to be documented from August 2023 through February, 2024. It is important for all required forms and files to be completed, signed, and/or posted to ensure necessary information is available to staff at all times during the facility’s operating hours for children enrolled. Ms. Lewis stated the facility has been short-staffed, and she has had to serve in a classroom frequently, but that she is updating all information as quickly as possible. You may consider developing a system for monitoring all required posted documentation and emergency information on a routine basis to ensure it is accessible, visible, and current. The diaper cream medication authorization form for one child enrolled in Space 5A was observed without a name of the medication; this was corrected during the visit. The diaper cream medication authorization form for one child enrolled in Space 5A was observed without the criteria of when to administer the cream. The sunscreen medication authorization forms for two children enrolled in Space 5A did not contain a parent’s signature. The topical medication authorization forms for two children enrolled in Space 7 were missing criteria for administration and the name of the medication, respectively. The name for the medication was added to the form during the visit. The topical medication authorization form for one child enrolled with bug spray wipes was not on file for review. The topical medication authorization forms for three children enrolled in Space 8 were not observed on file for review during the visit (one bug spray, one sunscreen, and one Chapstick). The topical medication authorization forms for five children enrolled in Space 8 did not contain a name of the medication; each of these was corrected during the visit. The diaper cream medication authorization form for one child in Space 9 did not contain a parent’s signature; the same form for another child enrolled in Space 9 did not contain the criteria for how much cream to administer. The prescription diaper cream for one child enrolled was not returned to the parent within 72 hours of the completion of treatment; this was corrected during the visit. It is imperative for all required medication documentation to be current and on file for review to ensure the health and safety of each child enrolled. Ms. Lewis and I discussed the idea of the facility considering providing a generic brand of sunscreen and/or bug spray for children during the summer months and pre-filling out each topical medication authorization form for parents (only requiring parental review, child’s name, signature, and date). You may also consider conducting monthly monitoring of all medication documentation for accuracy. In Spaces 3, 5A, 5B, 8, and 9, the art centers were either completely inaccessible to children or did not contain sufficient materials for three children to use the space at the same time. In Space 4, the home living center did not contain sufficient materials for three children to use the space at the same time. All art materials and home living materials were either added or made accessible to children in each classroom during the visit. Consultation Provided During Visit: • The following Child Care Rules were reviewed with Ms. Lewis during the visit: 10A NCAC 09 .0510 ACTIVITY AREAS (d) 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS On February 21, 2024, I emailed you a document regarding required Lead and Asbestos Testing. Ms. Lewis confirmed during today’s visit that the email was received and provided information that testing samples were analyzed on 4/10/2024; no further information was requested. Thank you for your time and assistance during this visit. At the completion of the visit, this visit summary, enrollment worksheet, and monitoring checklist were provided to you. Contact me at Cara McKeown, Child Care Consultant, (336) 408-4849 or cara.mckeown@dhhs.nc.gov or Pamela Hauser, Licensing Supervisor, pamela.hauser@dhhs.nc.gov if you have questions. 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: THE NEST SCHOOL Facility ID: 34001399 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 7/11/2024 Number Present: 103 Completed Date: 7/11/2024 Age: From 0 To 5 Total Minutes: 450 Time In: 10:00 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for an annual compliance visit. Krista Lewis, Center Director, assisted me with the visit. Your program currently operates with a four-star license, issued January 15, 2024, earning 5 points in the education component, 4 points in the program standards component (meeting enhanced ratios) and 1 quality point for the facility offering a staff benefits package and offering and infrastructure of parent involvement. The sanitation inspection was completed 9/06/2023 with a “Superior” classification. The last fire inspection was conducted 6/14/2024, and your facility was approved for daytime care only. The Secretary of State website was reviewed on 7/08/2024, and The Nest Schools, Inc. was listed as Current/ Active. The center's compliance history was reviewed with the operator. The program’s compliance history was 93% percent as of 7/08/24. All programs are required to maintain 75% compliance. Upon arrival, the license was posted. Nine classrooms were observed during this visit. All indoor and outdoor areas were observed during the visit. Upon arrival staff/child ratio was observed and recorded on the attached worksheet. Supervision was adequate during the visit. I observed developmentally appropriate materials and activities were available to the children in the classrooms. I observed the children playing in activity areas, participating in general routines, engaging in conversations and activities with their teachers, eating lunch, and napping during the visit. I observed interactions between staff and children. An allergy list was posted in each classroom and in the kitchen. Storage of hazardous items was monitored. Medication storage, emergency medication, action plans and parent authorization to administer medications were monitored. First Aid kits were monitored, and Safe Arrival and Departure procedures were posted at the main entrance of the building. This program does not currently provide transportation for children enrolled or participate in off-premise or aquatic activities. Staff and Training Worksheets were submitted prior to the visit. Due to time restrictions, staff and children’s files were not monitored during today’s visit; a follow-up visit will be conducted to monitor these records. Playground inspections, lockdown/ shelter-in-place drills and fire drill logs were monitored and observed to be in compliance for one year. A fire drill was conducted on 6/24/2024. A lockdown drill was completed on 6/14/2024. A playground inspection was completed on 6/24/2024. The following violations were cited during today's visit: Violation Number Comment Rule 114 A summary of the NC Child Care Law was not given to a parent of every child enrolled in the center. A signed receipt of the Summary of NC Child Care Law was not observed on file for one child enrolled. GS 110-102 428 A current activity plan was not posted for each group of children for reference. An activity plan was not posted in Space 7. GS 110-91(12); .0508(a) 468 When three year old children and older were in care, the materials and equipment in the activity area was not in sufficient quantity to allow at least three children to use the area regardless of whether the children choose the same or different activities. In Space 8, the art center did not contain sufficient materials for three children to use the space at the same time. .0510(d)(1) 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In Spaces 3, 5A, 5B, and 9, the art centers were completely inaccessible to children. In Space 4, the home living center did not contain sufficient materials for three children to use the space at the same time. .0510(e)(3) 508 Special diet or food allergy information was not posted where they can be seen in food preparation and eating areas. An Allergy List was not posted in Space 2. .0901(g) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. The infant feeding plans for two children enrolled (one in Space 1 and one in Space 9) were not signed by a parent or dated upon center receipt. .0902(a) 830 A First Aid information sheet was not posted in a place for referral and/or the information sheet did not include all the required information. The content included in on the First Aid poster posted in each classroom did not include First Aid guidance for scalds, head injuries, poisons, skin wounds, stings, and bites. .0802(h) 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. One bottle of coconut oil skin treatment labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 1. One bottle of hydrogen peroxide labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 3. One bottle of sunscreen labeled Keep Out of Reach of Children with additional warnings was observed hanging inside a bag, less than five feet from the ground in Space 8. .2820(b) 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 prescription diaper cream for one child enrolled was not returned to the parent within 72 hours of the completion of treatment. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space 9, a classroom for children one year of age, two plastic garbage bags were observed in an unlatched drawer located less than five feet from the ground, accessible to children. On the playground designated for children two years of age, two planters were observed to be lined with plastic liner which was observed to be shredding and could present a potential choking hazard. .0604(q) 893 A copy of the safe sleep policy was not given to and/or explained to the parent of each child on or before the first day the infant attended the center. The safe sleep policy for one child enrolled was not signed by a parent. 10A NCAC 09 .0606(c) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. An Emergency Information form was not observed on file for review for one substitute. .0701(a) 1314 Emergency information did not name childs health care professional. The application for one child enrolled did not contain a responsible party’s choice of health care professional. .0802(c)(2) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A lockdown/ shelter-in-place drill was not observed to be documented from August 2023 through February, 2024. .0604(u);.0302(d)(8) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The Ready to Go file did not contain applications for children enrolled, emergency contact information for 102 of the 125 children enrolled, staff contact information, medication authorizations and medical action plans, and copies of blank incident reports. .0607(d)(10) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. A signed notice of the EPR plan location was not observed on file for review for one substitute. .0607(g) 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. The signed Shaken Baby and Abusive Head Trauma Policy for one new employee was not observed on file for review. .0608(d)(1-4) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The diaper cream medication authorization form for one child enrolled in Space 5A was observed without a name of the medication. A diaper cream medication authorization form for one child enrolled in Space 5A was observed without the criteria of when to administer the cream. The sunscreen medication authorization forms for two children enrolled in Space 5A did not contain a parent’s signature. The topical medication authorization forms for two children enrolled in Space 7 were missing criteria for administration and the name of the medication, respectively. The topical medication authorization form for one child enrolled with bug spray wipes was not on file for review. The topical medication authorization forms for three children enrolled in Space 8 were not observed on file for review during the visit (one bug spray, one sunscreen, and one Chapstick). The topical medication authorization forms for five children enrolled in Space 8 did not contain a name of the medication. The diaper cream medication authorization form for one child in Space 9 did not contain a parent’s signature; the same form for another child enrolled in Space 9 did not contain the criteria for how much cream to administer. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. If additional violations are found in staff and children’s records during the follow-up visit, they will be added to today's visit summary. You must correct the violations found during today's visit immediately and send me documentation verifying compliance on or before 7/25/2024. The following information must be included in your compliance letter: • each violation number, • how you corrected each violation, • what plan will be implemented to prevent each violation from occurring again, • the name of your center, • facility ID number, • date, • title of the person who signs the letter If you state in your Compliance 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. You may email the letter to cara.mckeown@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical Assistance Provided During Visit: In Space 9, a classroom for children one year of age, two plastic garbage bags were observed in an unlatched drawer located less than five feet from the ground, accessible to children. Ms. Lewis placed these bags in a cupboard greater than five feet from the ground during the visit. On the playground designated for children two years of age, two planters were observed to be lined with plastic liner which was observed to be shredding and could present a potential choking hazard. Ms. Lewis stated this liner is typically covered by gardening soil, but that the children have been digging inside the planters and removing the soil. It is important for all areas (indoor and outdoor) accessed by children to be safe for exploration. You may consider creating a plan for monitoring the indoor and outdoor learning environments daily, prior to children arriving for care or accessing the outdoor learning environment. One bottle of coconut oil skin treatment labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 1; this item was placed into locked storage during the visit. One bottle of hydrogen peroxide labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 3; this item was placed into locked storage during the visit. One bottle of sunscreen labeled Keep Out of Reach of Children with additional warnings was observed hanging inside a bag, less than five feet from the ground in Space 8; this item was made inaccessible to children during the visit. An Allergy List was not posted in Space 2; this was corrected during the visit. An activity plan was not posted in Space 7; this activity plan was located and posted during the visit. The content included in on the First Aid poster posted in each classroom did not include First Aid guidance for scalds, head injuries, poisons, skin wounds, stings, and bites. The infant feeding plans for two children enrolled (one in Space 1 and one in Space 9) were not signed by a parent or dated upon center receipt. The Ready to Go file did not contain applications for children enrolled, emergency contact information for 102 of the 125 children enrolled, staff contact information, medication authorizations and medical action plans, and copies of blank incident reports. A lockdown/ shelter-in-place drill was not observed to be documented from August 2023 through February, 2024. It is important for all required forms and files to be completed, signed, and/or posted to ensure necessary information is available to staff at all times during the facility’s operating hours for children enrolled. Ms. Lewis stated the facility has been short-staffed, and she has had to serve in a classroom frequently, but that she is updating all information as quickly as possible. You may consider developing a system for monitoring all required posted documentation and emergency information on a routine basis to ensure it is accessible, visible, and current. The diaper cream medication authorization form for one child enrolled in Space 5A was observed without a name of the medication; this was corrected during the visit. The diaper cream medication authorization form for one child enrolled in Space 5A was observed without the criteria of when to administer the cream. The sunscreen medication authorization forms for two children enrolled in Space 5A did not contain a parent’s signature. The topical medication authorization forms for two children enrolled in Space 7 were missing criteria for administration and the name of the medication, respectively. The name for the medication was added to the form during the visit. The topical medication authorization form for one child enrolled with bug spray wipes was not on file for review. The topical medication authorization forms for three children enrolled in Space 8 were not observed on file for review during the visit (one bug spray, one sunscreen, and one Chapstick). The topical medication authorization forms for five children enrolled in Space 8 did not contain a name of the medication; each of these was corrected during the visit. The diaper cream medication authorization form for one child in Space 9 did not contain a parent’s signature; the same form for another child enrolled in Space 9 did not contain the criteria for how much cream to administer. The prescription diaper cream for one child enrolled was not returned to the parent within 72 hours of the completion of treatment; this was corrected during the visit. It is imperative for all required medication documentation to be current and on file for review to ensure the health and safety of each child enrolled. Ms. Lewis and I discussed the idea of the facility considering providing a generic brand of sunscreen and/or bug spray for children during the summer months and pre-filling out each topical medication authorization form for parents (only requiring parental review, child’s name, signature, and date). You may also consider conducting monthly monitoring of all medication documentation for accuracy. In Spaces 3, 5A, 5B, 8, and 9, the art centers were either completely inaccessible to children or did not contain sufficient materials for three children to use the space at the same time. In Space 4, the home living center did not contain sufficient materials for three children to use the space at the same time. All art materials and home living materials were either added or made accessible to children in each classroom during the visit. Consultation Provided During Visit: • The following Child Care Rules were reviewed with Ms. Lewis during the visit: 10A NCAC 09 .0510 ACTIVITY AREAS (d) 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS On February 21, 2024, I emailed you a document regarding required Lead and Asbestos Testing. Ms. Lewis confirmed during today’s visit that the email was received and provided information that testing samples were analyzed on 4/10/2024; no further information was requested. Thank you for your time and assistance during this visit. At the completion of the visit, this visit summary, enrollment worksheet, and monitoring checklist were provided to you. Contact me at Cara McKeown, Child Care Consultant, (336) 408-4849 or cara.mckeown@dhhs.nc.gov or Pamela Hauser, Licensing Supervisor, pamela.hauser@dhhs.nc.gov if you have questions. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: THE NEST SCHOOL Facility ID: 34001399 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 7/11/2024 Number Present: 103 Completed Date: 7/11/2024 Age: From 0 To 5 Total Minutes: 450 Time In: 10:00 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for an annual compliance visit. Krista Lewis, Center Director, assisted me with the visit. Your program currently operates with a four-star license, issued January 15, 2024, earning 5 points in the education component, 4 points in the program standards component (meeting enhanced ratios) and 1 quality point for the facility offering a staff benefits package and offering and infrastructure of parent involvement. The sanitation inspection was completed 9/06/2023 with a “Superior” classification. The last fire inspection was conducted 6/14/2024, and your facility was approved for daytime care only. The Secretary of State website was reviewed on 7/08/2024, and The Nest Schools, Inc. was listed as Current/ Active. The center's compliance history was reviewed with the operator. The program’s compliance history was 93% percent as of 7/08/24. All programs are required to maintain 75% compliance. Upon arrival, the license was posted. Nine classrooms were observed during this visit. All indoor and outdoor areas were observed during the visit. Upon arrival staff/child ratio was observed and recorded on the attached worksheet. Supervision was adequate during the visit. I observed developmentally appropriate materials and activities were available to the children in the classrooms. I observed the children playing in activity areas, participating in general routines, engaging in conversations and activities with their teachers, eating lunch, and napping during the visit. I observed interactions between staff and children. An allergy list was posted in each classroom and in the kitchen. Storage of hazardous items was monitored. Medication storage, emergency medication, action plans and parent authorization to administer medications were monitored. First Aid kits were monitored, and Safe Arrival and Departure procedures were posted at the main entrance of the building. This program does not currently provide transportation for children enrolled or participate in off-premise or aquatic activities. Staff and Training Worksheets were submitted prior to the visit. Due to time restrictions, staff and children’s files were not monitored during today’s visit; a follow-up visit will be conducted to monitor these records. Playground inspections, lockdown/ shelter-in-place drills and fire drill logs were monitored and observed to be in compliance for one year. A fire drill was conducted on 6/24/2024. A lockdown drill was completed on 6/14/2024. A playground inspection was completed on 6/24/2024. The following violations were cited during today's visit: Violation Number Comment Rule 114 A summary of the NC Child Care Law was not given to a parent of every child enrolled in the center. A signed receipt of the Summary of NC Child Care Law was not observed on file for one child enrolled. GS 110-102 428 A current activity plan was not posted for each group of children for reference. An activity plan was not posted in Space 7. GS 110-91(12); .0508(a) 468 When three year old children and older were in care, the materials and equipment in the activity area was not in sufficient quantity to allow at least three children to use the area regardless of whether the children choose the same or different activities. In Space 8, the art center did not contain sufficient materials for three children to use the space at the same time. .0510(d)(1) 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In Spaces 3, 5A, 5B, and 9, the art centers were completely inaccessible to children. In Space 4, the home living center did not contain sufficient materials for three children to use the space at the same time. .0510(e)(3) 508 Special diet or food allergy information was not posted where they can be seen in food preparation and eating areas. An Allergy List was not posted in Space 2. .0901(g) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. The infant feeding plans for two children enrolled (one in Space 1 and one in Space 9) were not signed by a parent or dated upon center receipt. .0902(a) 830 A First Aid information sheet was not posted in a place for referral and/or the information sheet did not include all the required information. The content included in on the First Aid poster posted in each classroom did not include First Aid guidance for scalds, head injuries, poisons, skin wounds, stings, and bites. .0802(h) 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. One bottle of coconut oil skin treatment labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 1. One bottle of hydrogen peroxide labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 3. One bottle of sunscreen labeled Keep Out of Reach of Children with additional warnings was observed hanging inside a bag, less than five feet from the ground in Space 8. .2820(b) 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 prescription diaper cream for one child enrolled was not returned to the parent within 72 hours of the completion of treatment. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space 9, a classroom for children one year of age, two plastic garbage bags were observed in an unlatched drawer located less than five feet from the ground, accessible to children. On the playground designated for children two years of age, two planters were observed to be lined with plastic liner which was observed to be shredding and could present a potential choking hazard. .0604(q) 893 A copy of the safe sleep policy was not given to and/or explained to the parent of each child on or before the first day the infant attended the center. The safe sleep policy for one child enrolled was not signed by a parent. 10A NCAC 09 .0606(c) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. An Emergency Information form was not observed on file for review for one substitute. .0701(a) 1314 Emergency information did not name childs health care professional. The application for one child enrolled did not contain a responsible party’s choice of health care professional. .0802(c)(2) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A lockdown/ shelter-in-place drill was not observed to be documented from August 2023 through February, 2024. .0604(u);.0302(d)(8) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The Ready to Go file did not contain applications for children enrolled, emergency contact information for 102 of the 125 children enrolled, staff contact information, medication authorizations and medical action plans, and copies of blank incident reports. .0607(d)(10) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. A signed notice of the EPR plan location was not observed on file for review for one substitute. .0607(g) 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. The signed Shaken Baby and Abusive Head Trauma Policy for one new employee was not observed on file for review. .0608(d)(1-4) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The diaper cream medication authorization form for one child enrolled in Space 5A was observed without a name of the medication. A diaper cream medication authorization form for one child enrolled in Space 5A was observed without the criteria of when to administer the cream. The sunscreen medication authorization forms for two children enrolled in Space 5A did not contain a parent’s signature. The topical medication authorization forms for two children enrolled in Space 7 were missing criteria for administration and the name of the medication, respectively. The topical medication authorization form for one child enrolled with bug spray wipes was not on file for review. The topical medication authorization forms for three children enrolled in Space 8 were not observed on file for review during the visit (one bug spray, one sunscreen, and one Chapstick). The topical medication authorization forms for five children enrolled in Space 8 did not contain a name of the medication. The diaper cream medication authorization form for one child in Space 9 did not contain a parent’s signature; the same form for another child enrolled in Space 9 did not contain the criteria for how much cream to administer. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. If additional violations are found in staff and children’s records during the follow-up visit, they will be added to today's visit summary. You must correct the violations found during today's visit immediately and send me documentation verifying compliance on or before 7/25/2024. The following information must be included in your compliance letter: • each violation number, • how you corrected each violation, • what plan will be implemented to prevent each violation from occurring again, • the name of your center, • facility ID number, • date, • title of the person who signs the letter If you state in your Compliance 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. You may email the letter to cara.mckeown@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical Assistance Provided During Visit: In Space 9, a classroom for children one year of age, two plastic garbage bags were observed in an unlatched drawer located less than five feet from the ground, accessible to children. Ms. Lewis placed these bags in a cupboard greater than five feet from the ground during the visit. On the playground designated for children two years of age, two planters were observed to be lined with plastic liner which was observed to be shredding and could present a potential choking hazard. Ms. Lewis stated this liner is typically covered by gardening soil, but that the children have been digging inside the planters and removing the soil. It is important for all areas (indoor and outdoor) accessed by children to be safe for exploration. You may consider creating a plan for monitoring the indoor and outdoor learning environments daily, prior to children arriving for care or accessing the outdoor learning environment. One bottle of coconut oil skin treatment labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 1; this item was placed into locked storage during the visit. One bottle of hydrogen peroxide labeled Keep Out of Reach of Children with additional warnings was observed greater than five feet up, but in unlocked storage in Space 3; this item was placed into locked storage during the visit. One bottle of sunscreen labeled Keep Out of Reach of Children with additional warnings was observed hanging inside a bag, less than five feet from the ground in Space 8; this item was made inaccessible to children during the visit. An Allergy List was not posted in Space 2; this was corrected during the visit. An activity plan was not posted in Space 7; this activity plan was located and posted during the visit. The content included in on the First Aid poster posted in each classroom did not include First Aid guidance for scalds, head injuries, poisons, skin wounds, stings, and bites. The infant feeding plans for two children enrolled (one in Space 1 and one in Space 9) were not signed by a parent or dated upon center receipt. The Ready to Go file did not contain applications for children enrolled, emergency contact information for 102 of the 125 children enrolled, staff contact information, medication authorizations and medical action plans, and copies of blank incident reports. A lockdown/ shelter-in-place drill was not observed to be documented from August 2023 through February, 2024. It is important for all required forms and files to be completed, signed, and/or posted to ensure necessary information is available to staff at all times during the facility’s operating hours for children enrolled. Ms. Lewis stated the facility has been short-staffed, and she has had to serve in a classroom frequently, but that she is updating all information as quickly as possible. You may consider developing a system for monitoring all required posted documentation and emergency information on a routine basis to ensure it is accessible, visible, and current. The diaper cream medication authorization form for one child enrolled in Space 5A was observed without a name of the medication; this was corrected during the visit. The diaper cream medication authorization form for one child enrolled in Space 5A was observed without the criteria of when to administer the cream. The sunscreen medication authorization forms for two children enrolled in Space 5A did not contain a parent’s signature. The topical medication authorization forms for two children enrolled in Space 7 were missing criteria for administration and the name of the medication, respectively. The name for the medication was added to the form during the visit. The topical medication authorization form for one child enrolled with bug spray wipes was not on file for review. The topical medication authorization forms for three children enrolled in Space 8 were not observed on file for review during the visit (one bug spray, one sunscreen, and one Chapstick). The topical medication authorization forms for five children enrolled in Space 8 did not contain a name of the medication; each of these was corrected during the visit. The diaper cream medication authorization form for one child in Space 9 did not contain a parent’s signature; the same form for another child enrolled in Space 9 did not contain the criteria for how much cream to administer. The prescription diaper cream for one child enrolled was not returned to the parent within 72 hours of the completion of treatment; this was corrected during the visit. It is imperative for all required medication documentation to be current and on file for review to ensure the health and safety of each child enrolled. Ms. Lewis and I discussed the idea of the facility considering providing a generic brand of sunscreen and/or bug spray for children during the summer months and pre-filling out each topical medication authorization form for parents (only requiring parental review, child’s name, signature, and date). You may also consider conducting monthly monitoring of all medication documentation for accuracy. In Spaces 3, 5A, 5B, 8, and 9, the art centers were either completely inaccessible to children or did not contain sufficient materials for three children to use the space at the same time. In Space 4, the home living center did not contain sufficient materials for three children to use the space at the same time. All art materials and home living materials were either added or made accessible to children in each classroom during the visit. Consultation Provided During Visit: • The following Child Care Rules were reviewed with Ms. Lewis during the visit: 10A NCAC 09 .0510 ACTIVITY AREAS (d) 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS On February 21, 2024, I emailed you a document regarding required Lead and Asbestos Testing. Ms. Lewis confirmed during today’s visit that the email was received and provided information that testing samples were analyzed on 4/10/2024; no further information was requested. Thank you for your time and assistance during this visit. At the completion of the visit, this visit summary, enrollment worksheet, and monitoring checklist were provided to you. Contact me at Cara McKeown, Child Care Consultant, (336) 408-4849 or cara.mckeown@dhhs.nc.gov or Pamela Hauser, Licensing Supervisor, pamela.hauser@dhhs.nc.gov if you have questions. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0901 · Violation

Name of Operation: THE NEST SCHOOL Facility ID: 34001399 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: Visit Date: 10/23/2023 Number Present: 59 Completed Date: 10/23/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 10:10 AM Time Out: 02:10 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the second temporary time period visit and to discuss preparation for a rated license assessment. The visit was conducted with Krista Lewis, Director, by Tammy Childress, Lead Child Care Consultant. Currently this facility operates with a Temporary License, issued on July 14, 2023, to operate first shift to provide care for children ages zero to twelve years old. Restrictions are daytime care only, and children under 2 ½ years old in rooms with direct exits only. The Secretary of State website was checked today, and the owner, The Nest Schools, Inc., remains current on all required documents and active on the NC Business Registry. If any changes to the business type need to be made or you decide to sale your business, then you must notify your consultant at least thirty days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. All designated indoor and outdoor spaces for child care were monitored, as well as all staff files and a percentage of enrolled children’s files. All program records and documents required to be posted were monitored. The facility does not provide transportation. Meals are prepared on-site and are eaten in the classroom. During today’s visit children present were observed to be engaged in outdoor play, free choice, personal care routines, lunch, and nap. Ms. Lewis stated that facility staff use the approved Nest curriculum. The following violations were cited today: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. The activity plan posted in Space 1 was for the previous week and the plan posted in Space 2 was for 2 weeks prior to today. GS 110-91(12); .0508(a) 501 Meals/snacks did not comply with the Meal Patterns for Children in Child Care Programs. Two children in Space 8 were served water with lunch and there was no documentation on file regarding special diet. One of the children had a nutritional opt-out form on file for milk only and the parent had crossed out the words meals and snacks. The same two children were not served breakfast today because the children stated they did not want breakfast and the staff member said they never eat breakfast. 10A NCAC 09 .0901(a) 9995 A violation was found for which there is no item number. Two children in Space 8 were served water from the classroom handwash sink, a violation of 15A NCAC 18A .2818(a)In child care centers, lavatories shall be kept clean and in good repair and shall not be used for storage. Lavatories shall be mounted at an appropriate height to accommodate children or otherwise made accessible to children. Water from a handwash lavatory shall not be used for consumption. Lavatories with flush-rimmed sinks or with an attached operable drinking fountain shall not be used for handwashing. 9996 A violation was found for which there is no item number. Children's cots were not labeled, numbered and documented on a posted cot list in Space 4, a violation of 15A NCAC 18A .2821(c) Beds, cots, and mats shall be assigned and labeled for use by an individual child and equipped with individual linens. All violations must be corrected immediately. You must submit documentation on how each violation was corrected to Ms. Childress by November 6, 2023. The documentation should be submitted by email to Ms. Childress at tammy.childress@dhhs.nc.gov. During today’s visit we again discussed the Rated License Assessment Process and the Environment Rating Scale Assessment. The application for a Star Rated License Assessment and Request for an Environment Rating Scale Assessment was received on October 11, 2023. You should prepare for the ERS Assessment by reviewing the Early Childhood Environment Rating Scale (revised edition) booklets, visit the North Carolina Rated License Assessment Project website at www.ncrlap.org and review resource guides/additional notes/ informational videos and participate in the free online training. For technical assistance in preparing for the Environment Rating Scale Assessment, you may also contact your local resource and referral agency at: Smart Start of Forsyth County 7820 North Point Blvd #200 Winston-Salem, NC 27106 336-725-6011 https://smartstart-fc.org Your Temporary License will expire on January 14, 2024, and in order to continue to operate you must be issued a star rated license. In order to continue to participate in the NC Subsidized Child Care Program, you must be issued a license with Three Stars or higher. Technical Assistance: Activity Plans Ensure that the activity plans posted are for the current week. See Activity Plan samples for Infants and Toddlers found on the DCDEE website under provider documents and forms. 10A NCAC 09 .0508 (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Handwashing Review handwashing steps and supervision with staff. After children wash their hands, the children should not touch trash can lids. Trash cans should not be placed at the sink where children are moving the trashcan to get to the soap dispenser and trashcans should be emptied when full as soon as possible. Cot Lists Cots must be labeled and numbered for each child and be reflected on the posted cot list. If changes occur regarding the children receiving care in the classroom, the cot list should be updated immediately and the cots immediately correctly labeled and numbered. Making changes as they occur will prevent staff from having to determine which cot belongs to which child when naptime occurs, not interfere with the naptime routine for children, and will allow staff to be able to supervise children at this time. Nutrition Meal pattern requirements for children must be followed at all times. Meal patterns include serving the appropriate type and amount of milk daily. Serving is defined as putting the milk in a cup and placing it on the table with the child’s meals and snacks. If the child chooses not to drink the milk, water can be given in addition to the milk. If there is a parental preference that milk is not served to a child, the parent needs to document this and either provide an approved milk substitute, or both milk and water must be served. A parent cannot complete a Nutritional Opt Out form for milk only. Also, staff should not ask children if they want a meal or snack. The meal or snack must be placed on the table in front of the child. If the child chooses not to eat the meal or snack, then staff have taken the appropriate steps to meet meal pattern requirements. Regardless of whether or not sinks have been tested for lead, water from handwashing sinks can never be consumed. Transition Activities Explore ways to make transition times clearly understood, short in length, meaningful and fun. Reach out for technical assistance if needed from Smart Start and Ms. Childress. Moving from one activity to the next can be a time of confusion, frustration, and challenging behaviors for some children. -Explain It: Before going into an activity, talk with children as a group and use “first” and “then” language. In simple, short terms tell the children what they are doing first and what they are doing then. -Use Visual Supports: Create picture daily schedule cards, showing actual pictures of the children and/or actual objects in the classroom demonstrating the first and then. -Use Verbal or other Audible Prompts: Timers, bells, verbal warnings that we are moving from one activity to the next and use first and then language. -Make it Fun: Use simple games (like I Spy or hop to the carpet like a ____, when your area is clean, wave your hands above your head like a tree in the wind after your hands are washed, etc.) songs (sing them together or use applications like Spotify) to avoid children being distracted/more interested in the visual display on the smart board. Use songs as you line up for hallway transitions ( Google it- there are some great ones! Hallway Rap, Marshmallow Mouths and Toes) and have a plan for an activity when you get where you are going. -Praise and Encourage: Verbally express to children that you see them doing a great job! -Double Check the Daily Schedule: Consider and reconsider if the times allotted for transitions and activities work- are transition times too long? Are the times between cleaning up, handwashing and waiting for lunch to be served too long? Visit the DCDEE website at https://ncchildcare.ncdhhs.gov. From the home screen, hover your cursor over the “Provider” tab at the top of the page, from the drop down options hover over “Training and Professional Development” and lastly select (click on) “DCDEE Moodle” from the option menu to your right. Login to Moodle using your NCID username and password. From the carousel of pictures at the top of the page, select “View Early Childhood Professional Development.” Then select “Regulatory” and finally select “Child Care Rule Rollout” as a way to become more familiar with child care center rules. Also, on the DCDEE website home page, under the “Provider” tab, you can select “Child Care Rules” and on the next page select “Chapter 9- Child Care Rules.” You should download the rules for easier access. When needing to review a rule for quick reference you can use the keyboard keys “Ctrl” + “F” at the same time to prompt a search bar to appear and you can enter keywords for any rule. The keywords are then highlighted throughout the rules, and you can navigate through them using the up and down arrows. Sensory Play The use of shaving cream by children in child care centers is not recommended under any circumstances. Research completed by regional children’s environmental health specialist found that specifically Barbasol Shaving Cream, could cause nausea, vomiting and diarrhea from ingestion, minor eye irritation from eye contact, and irritation from prolonged skin contact. Pfizer Consumer Health Care Division, maker of Barbasol Shaving Cream, indicated that shaving cream was not formulated or tested for use in child care settings and therefore could not recommend it for use. This research and statement position by environmental health applies to any brand of shaving cream. We discussed other alternatives such as whipped cream and googling taste safe sensory foam that you can make with only a few ingredients. There are various materials that meet requirements in place of sand play, which are often seen in sensory bins filled with items such as rice, lentils, birdseed, cornmeal, wet sand, sterilized potting soil, and woodchips, whole and dried corn kernels. It is important not to use any items that could be considered choking hazards for preschoolers, such as larger dried beans, acorns. When using an approved sand substitute make sure that there is enough of the material to allow children to dig, scoop, pour and fill and that there are accessory items such as cups and spoons. The “measuring” types of toys can be alternated with items such as cars, trucks, people, animals, tools for making designs in sand, etcetera, but if using in rotation the measuring types of toys must be available to be monitored. Some suggestions for water play include added color and objects to the water with the same types of accessory items. Water play can also include bathing dolls, dishes for housekeeping, or trucks and cars at a car wash. Be creative, but also allow children opportunities to gain experience and explore with sand and water. Emergency Preparedness and Response Plan Emergency Preparedness and Response in Child Care training must be completed by at least one staff member (usually the administrator) within one year of the effective date of the initial license. Maintain documentation of this training. Once the EPR training is completed, you must complete an EPR Plan on a template at the following website https://rmp.nc.gov/portal/portal.aspx within four (4) months. After you complete the Emergency Preparedness and Response in Child Care training, you must conduct either a shelter-in-place or a lockdown drill every three months. Use the Emergency Drill Log to document these drills as well as the fire drills. The form is located under the Provider Documents tab on the DCDEE website at www.ncchildcare.ncdhhs.gov. A summary of today’s visit was reviewed with and provided to Ms. Lewis. Ms. Lewis was given the opportunity to ask any questions. If you have any further questions about today’s visit, please contact Ms. Childress at tammy.childress@dhhs.nc.gov or by telephone at (336)317-6436. You may also contact the Licensing Supervisor, Pamela Hauser, at pamela.hauser@dhhs.nc.gov if you have concerns regarding today’s visit or any violations documented. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .0508 · Violation

Name of Operation: THE NEST SCHOOL Facility ID: 34001399 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: Visit Date: 10/23/2023 Number Present: 59 Completed Date: 10/23/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 10:10 AM Time Out: 02:10 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the second temporary time period visit and to discuss preparation for a rated license assessment. The visit was conducted with Krista Lewis, Director, by Tammy Childress, Lead Child Care Consultant. Currently this facility operates with a Temporary License, issued on July 14, 2023, to operate first shift to provide care for children ages zero to twelve years old. Restrictions are daytime care only, and children under 2 ½ years old in rooms with direct exits only. The Secretary of State website was checked today, and the owner, The Nest Schools, Inc., remains current on all required documents and active on the NC Business Registry. If any changes to the business type need to be made or you decide to sale your business, then you must notify your consultant at least thirty days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. All designated indoor and outdoor spaces for child care were monitored, as well as all staff files and a percentage of enrolled children’s files. All program records and documents required to be posted were monitored. The facility does not provide transportation. Meals are prepared on-site and are eaten in the classroom. During today’s visit children present were observed to be engaged in outdoor play, free choice, personal care routines, lunch, and nap. Ms. Lewis stated that facility staff use the approved Nest curriculum. The following violations were cited today: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. The activity plan posted in Space 1 was for the previous week and the plan posted in Space 2 was for 2 weeks prior to today. GS 110-91(12); .0508(a) 501 Meals/snacks did not comply with the Meal Patterns for Children in Child Care Programs. Two children in Space 8 were served water with lunch and there was no documentation on file regarding special diet. One of the children had a nutritional opt-out form on file for milk only and the parent had crossed out the words meals and snacks. The same two children were not served breakfast today because the children stated they did not want breakfast and the staff member said they never eat breakfast. 10A NCAC 09 .0901(a) 9995 A violation was found for which there is no item number. Two children in Space 8 were served water from the classroom handwash sink, a violation of 15A NCAC 18A .2818(a)In child care centers, lavatories shall be kept clean and in good repair and shall not be used for storage. Lavatories shall be mounted at an appropriate height to accommodate children or otherwise made accessible to children. Water from a handwash lavatory shall not be used for consumption. Lavatories with flush-rimmed sinks or with an attached operable drinking fountain shall not be used for handwashing. 9996 A violation was found for which there is no item number. Children's cots were not labeled, numbered and documented on a posted cot list in Space 4, a violation of 15A NCAC 18A .2821(c) Beds, cots, and mats shall be assigned and labeled for use by an individual child and equipped with individual linens. All violations must be corrected immediately. You must submit documentation on how each violation was corrected to Ms. Childress by November 6, 2023. The documentation should be submitted by email to Ms. Childress at tammy.childress@dhhs.nc.gov. During today’s visit we again discussed the Rated License Assessment Process and the Environment Rating Scale Assessment. The application for a Star Rated License Assessment and Request for an Environment Rating Scale Assessment was received on October 11, 2023. You should prepare for the ERS Assessment by reviewing the Early Childhood Environment Rating Scale (revised edition) booklets, visit the North Carolina Rated License Assessment Project website at www.ncrlap.org and review resource guides/additional notes/ informational videos and participate in the free online training. For technical assistance in preparing for the Environment Rating Scale Assessment, you may also contact your local resource and referral agency at: Smart Start of Forsyth County 7820 North Point Blvd #200 Winston-Salem, NC 27106 336-725-6011 https://smartstart-fc.org Your Temporary License will expire on January 14, 2024, and in order to continue to operate you must be issued a star rated license. In order to continue to participate in the NC Subsidized Child Care Program, you must be issued a license with Three Stars or higher. Technical Assistance: Activity Plans Ensure that the activity plans posted are for the current week. See Activity Plan samples for Infants and Toddlers found on the DCDEE website under provider documents and forms. 10A NCAC 09 .0508 (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Handwashing Review handwashing steps and supervision with staff. After children wash their hands, the children should not touch trash can lids. Trash cans should not be placed at the sink where children are moving the trashcan to get to the soap dispenser and trashcans should be emptied when full as soon as possible. Cot Lists Cots must be labeled and numbered for each child and be reflected on the posted cot list. If changes occur regarding the children receiving care in the classroom, the cot list should be updated immediately and the cots immediately correctly labeled and numbered. Making changes as they occur will prevent staff from having to determine which cot belongs to which child when naptime occurs, not interfere with the naptime routine for children, and will allow staff to be able to supervise children at this time. Nutrition Meal pattern requirements for children must be followed at all times. Meal patterns include serving the appropriate type and amount of milk daily. Serving is defined as putting the milk in a cup and placing it on the table with the child’s meals and snacks. If the child chooses not to drink the milk, water can be given in addition to the milk. If there is a parental preference that milk is not served to a child, the parent needs to document this and either provide an approved milk substitute, or both milk and water must be served. A parent cannot complete a Nutritional Opt Out form for milk only. Also, staff should not ask children if they want a meal or snack. The meal or snack must be placed on the table in front of the child. If the child chooses not to eat the meal or snack, then staff have taken the appropriate steps to meet meal pattern requirements. Regardless of whether or not sinks have been tested for lead, water from handwashing sinks can never be consumed. Transition Activities Explore ways to make transition times clearly understood, short in length, meaningful and fun. Reach out for technical assistance if needed from Smart Start and Ms. Childress. Moving from one activity to the next can be a time of confusion, frustration, and challenging behaviors for some children. -Explain It: Before going into an activity, talk with children as a group and use “first” and “then” language. In simple, short terms tell the children what they are doing first and what they are doing then. -Use Visual Supports: Create picture daily schedule cards, showing actual pictures of the children and/or actual objects in the classroom demonstrating the first and then. -Use Verbal or other Audible Prompts: Timers, bells, verbal warnings that we are moving from one activity to the next and use first and then language. -Make it Fun: Use simple games (like I Spy or hop to the carpet like a ____, when your area is clean, wave your hands above your head like a tree in the wind after your hands are washed, etc.) songs (sing them together or use applications like Spotify) to avoid children being distracted/more interested in the visual display on the smart board. Use songs as you line up for hallway transitions ( Google it- there are some great ones! Hallway Rap, Marshmallow Mouths and Toes) and have a plan for an activity when you get where you are going. -Praise and Encourage: Verbally express to children that you see them doing a great job! -Double Check the Daily Schedule: Consider and reconsider if the times allotted for transitions and activities work- are transition times too long? Are the times between cleaning up, handwashing and waiting for lunch to be served too long? Visit the DCDEE website at https://ncchildcare.ncdhhs.gov. From the home screen, hover your cursor over the “Provider” tab at the top of the page, from the drop down options hover over “Training and Professional Development” and lastly select (click on) “DCDEE Moodle” from the option menu to your right. Login to Moodle using your NCID username and password. From the carousel of pictures at the top of the page, select “View Early Childhood Professional Development.” Then select “Regulatory” and finally select “Child Care Rule Rollout” as a way to become more familiar with child care center rules. Also, on the DCDEE website home page, under the “Provider” tab, you can select “Child Care Rules” and on the next page select “Chapter 9- Child Care Rules.” You should download the rules for easier access. When needing to review a rule for quick reference you can use the keyboard keys “Ctrl” + “F” at the same time to prompt a search bar to appear and you can enter keywords for any rule. The keywords are then highlighted throughout the rules, and you can navigate through them using the up and down arrows. Sensory Play The use of shaving cream by children in child care centers is not recommended under any circumstances. Research completed by regional children’s environmental health specialist found that specifically Barbasol Shaving Cream, could cause nausea, vomiting and diarrhea from ingestion, minor eye irritation from eye contact, and irritation from prolonged skin contact. Pfizer Consumer Health Care Division, maker of Barbasol Shaving Cream, indicated that shaving cream was not formulated or tested for use in child care settings and therefore could not recommend it for use. This research and statement position by environmental health applies to any brand of shaving cream. We discussed other alternatives such as whipped cream and googling taste safe sensory foam that you can make with only a few ingredients. There are various materials that meet requirements in place of sand play, which are often seen in sensory bins filled with items such as rice, lentils, birdseed, cornmeal, wet sand, sterilized potting soil, and woodchips, whole and dried corn kernels. It is important not to use any items that could be considered choking hazards for preschoolers, such as larger dried beans, acorns. When using an approved sand substitute make sure that there is enough of the material to allow children to dig, scoop, pour and fill and that there are accessory items such as cups and spoons. The “measuring” types of toys can be alternated with items such as cars, trucks, people, animals, tools for making designs in sand, etcetera, but if using in rotation the measuring types of toys must be available to be monitored. Some suggestions for water play include added color and objects to the water with the same types of accessory items. Water play can also include bathing dolls, dishes for housekeeping, or trucks and cars at a car wash. Be creative, but also allow children opportunities to gain experience and explore with sand and water. Emergency Preparedness and Response Plan Emergency Preparedness and Response in Child Care training must be completed by at least one staff member (usually the administrator) within one year of the effective date of the initial license. Maintain documentation of this training. Once the EPR training is completed, you must complete an EPR Plan on a template at the following website https://rmp.nc.gov/portal/portal.aspx within four (4) months. After you complete the Emergency Preparedness and Response in Child Care training, you must conduct either a shelter-in-place or a lockdown drill every three months. Use the Emergency Drill Log to document these drills as well as the fire drills. The form is located under the Provider Documents tab on the DCDEE website at www.ncchildcare.ncdhhs.gov. A summary of today’s visit was reviewed with and provided to Ms. Lewis. Ms. Lewis was given the opportunity to ask any questions. If you have any further questions about today’s visit, please contact Ms. Childress at tammy.childress@dhhs.nc.gov or by telephone at (336)317-6436. You may also contact the Licensing Supervisor, Pamela Hauser, at pamela.hauser@dhhs.nc.gov if you have concerns regarding today’s visit or any violations documented. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS 110-91 · Violation

Name of Operation: THE NEST SCHOOL Facility ID: 34001399 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: Visit Date: 10/23/2023 Number Present: 59 Completed Date: 10/23/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 10:10 AM Time Out: 02:10 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the second temporary time period visit and to discuss preparation for a rated license assessment. The visit was conducted with Krista Lewis, Director, by Tammy Childress, Lead Child Care Consultant. Currently this facility operates with a Temporary License, issued on July 14, 2023, to operate first shift to provide care for children ages zero to twelve years old. Restrictions are daytime care only, and children under 2 ½ years old in rooms with direct exits only. The Secretary of State website was checked today, and the owner, The Nest Schools, Inc., remains current on all required documents and active on the NC Business Registry. If any changes to the business type need to be made or you decide to sale your business, then you must notify your consultant at least thirty days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. All designated indoor and outdoor spaces for child care were monitored, as well as all staff files and a percentage of enrolled children’s files. All program records and documents required to be posted were monitored. The facility does not provide transportation. Meals are prepared on-site and are eaten in the classroom. During today’s visit children present were observed to be engaged in outdoor play, free choice, personal care routines, lunch, and nap. Ms. Lewis stated that facility staff use the approved Nest curriculum. The following violations were cited today: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. The activity plan posted in Space 1 was for the previous week and the plan posted in Space 2 was for 2 weeks prior to today. GS 110-91(12); .0508(a) 501 Meals/snacks did not comply with the Meal Patterns for Children in Child Care Programs. Two children in Space 8 were served water with lunch and there was no documentation on file regarding special diet. One of the children had a nutritional opt-out form on file for milk only and the parent had crossed out the words meals and snacks. The same two children were not served breakfast today because the children stated they did not want breakfast and the staff member said they never eat breakfast. 10A NCAC 09 .0901(a) 9995 A violation was found for which there is no item number. Two children in Space 8 were served water from the classroom handwash sink, a violation of 15A NCAC 18A .2818(a)In child care centers, lavatories shall be kept clean and in good repair and shall not be used for storage. Lavatories shall be mounted at an appropriate height to accommodate children or otherwise made accessible to children. Water from a handwash lavatory shall not be used for consumption. Lavatories with flush-rimmed sinks or with an attached operable drinking fountain shall not be used for handwashing. 9996 A violation was found for which there is no item number. Children's cots were not labeled, numbered and documented on a posted cot list in Space 4, a violation of 15A NCAC 18A .2821(c) Beds, cots, and mats shall be assigned and labeled for use by an individual child and equipped with individual linens. All violations must be corrected immediately. You must submit documentation on how each violation was corrected to Ms. Childress by November 6, 2023. The documentation should be submitted by email to Ms. Childress at tammy.childress@dhhs.nc.gov. During today’s visit we again discussed the Rated License Assessment Process and the Environment Rating Scale Assessment. The application for a Star Rated License Assessment and Request for an Environment Rating Scale Assessment was received on October 11, 2023. You should prepare for the ERS Assessment by reviewing the Early Childhood Environment Rating Scale (revised edition) booklets, visit the North Carolina Rated License Assessment Project website at www.ncrlap.org and review resource guides/additional notes/ informational videos and participate in the free online training. For technical assistance in preparing for the Environment Rating Scale Assessment, you may also contact your local resource and referral agency at: Smart Start of Forsyth County 7820 North Point Blvd #200 Winston-Salem, NC 27106 336-725-6011 https://smartstart-fc.org Your Temporary License will expire on January 14, 2024, and in order to continue to operate you must be issued a star rated license. In order to continue to participate in the NC Subsidized Child Care Program, you must be issued a license with Three Stars or higher. Technical Assistance: Activity Plans Ensure that the activity plans posted are for the current week. See Activity Plan samples for Infants and Toddlers found on the DCDEE website under provider documents and forms. 10A NCAC 09 .0508 (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Handwashing Review handwashing steps and supervision with staff. After children wash their hands, the children should not touch trash can lids. Trash cans should not be placed at the sink where children are moving the trashcan to get to the soap dispenser and trashcans should be emptied when full as soon as possible. Cot Lists Cots must be labeled and numbered for each child and be reflected on the posted cot list. If changes occur regarding the children receiving care in the classroom, the cot list should be updated immediately and the cots immediately correctly labeled and numbered. Making changes as they occur will prevent staff from having to determine which cot belongs to which child when naptime occurs, not interfere with the naptime routine for children, and will allow staff to be able to supervise children at this time. Nutrition Meal pattern requirements for children must be followed at all times. Meal patterns include serving the appropriate type and amount of milk daily. Serving is defined as putting the milk in a cup and placing it on the table with the child’s meals and snacks. If the child chooses not to drink the milk, water can be given in addition to the milk. If there is a parental preference that milk is not served to a child, the parent needs to document this and either provide an approved milk substitute, or both milk and water must be served. A parent cannot complete a Nutritional Opt Out form for milk only. Also, staff should not ask children if they want a meal or snack. The meal or snack must be placed on the table in front of the child. If the child chooses not to eat the meal or snack, then staff have taken the appropriate steps to meet meal pattern requirements. Regardless of whether or not sinks have been tested for lead, water from handwashing sinks can never be consumed. Transition Activities Explore ways to make transition times clearly understood, short in length, meaningful and fun. Reach out for technical assistance if needed from Smart Start and Ms. Childress. Moving from one activity to the next can be a time of confusion, frustration, and challenging behaviors for some children. -Explain It: Before going into an activity, talk with children as a group and use “first” and “then” language. In simple, short terms tell the children what they are doing first and what they are doing then. -Use Visual Supports: Create picture daily schedule cards, showing actual pictures of the children and/or actual objects in the classroom demonstrating the first and then. -Use Verbal or other Audible Prompts: Timers, bells, verbal warnings that we are moving from one activity to the next and use first and then language. -Make it Fun: Use simple games (like I Spy or hop to the carpet like a ____, when your area is clean, wave your hands above your head like a tree in the wind after your hands are washed, etc.) songs (sing them together or use applications like Spotify) to avoid children being distracted/more interested in the visual display on the smart board. Use songs as you line up for hallway transitions ( Google it- there are some great ones! Hallway Rap, Marshmallow Mouths and Toes) and have a plan for an activity when you get where you are going. -Praise and Encourage: Verbally express to children that you see them doing a great job! -Double Check the Daily Schedule: Consider and reconsider if the times allotted for transitions and activities work- are transition times too long? Are the times between cleaning up, handwashing and waiting for lunch to be served too long? Visit the DCDEE website at https://ncchildcare.ncdhhs.gov. From the home screen, hover your cursor over the “Provider” tab at the top of the page, from the drop down options hover over “Training and Professional Development” and lastly select (click on) “DCDEE Moodle” from the option menu to your right. Login to Moodle using your NCID username and password. From the carousel of pictures at the top of the page, select “View Early Childhood Professional Development.” Then select “Regulatory” and finally select “Child Care Rule Rollout” as a way to become more familiar with child care center rules. Also, on the DCDEE website home page, under the “Provider” tab, you can select “Child Care Rules” and on the next page select “Chapter 9- Child Care Rules.” You should download the rules for easier access. When needing to review a rule for quick reference you can use the keyboard keys “Ctrl” + “F” at the same time to prompt a search bar to appear and you can enter keywords for any rule. The keywords are then highlighted throughout the rules, and you can navigate through them using the up and down arrows. Sensory Play The use of shaving cream by children in child care centers is not recommended under any circumstances. Research completed by regional children’s environmental health specialist found that specifically Barbasol Shaving Cream, could cause nausea, vomiting and diarrhea from ingestion, minor eye irritation from eye contact, and irritation from prolonged skin contact. Pfizer Consumer Health Care Division, maker of Barbasol Shaving Cream, indicated that shaving cream was not formulated or tested for use in child care settings and therefore could not recommend it for use. This research and statement position by environmental health applies to any brand of shaving cream. We discussed other alternatives such as whipped cream and googling taste safe sensory foam that you can make with only a few ingredients. There are various materials that meet requirements in place of sand play, which are often seen in sensory bins filled with items such as rice, lentils, birdseed, cornmeal, wet sand, sterilized potting soil, and woodchips, whole and dried corn kernels. It is important not to use any items that could be considered choking hazards for preschoolers, such as larger dried beans, acorns. When using an approved sand substitute make sure that there is enough of the material to allow children to dig, scoop, pour and fill and that there are accessory items such as cups and spoons. The “measuring” types of toys can be alternated with items such as cars, trucks, people, animals, tools for making designs in sand, etcetera, but if using in rotation the measuring types of toys must be available to be monitored. Some suggestions for water play include added color and objects to the water with the same types of accessory items. Water play can also include bathing dolls, dishes for housekeeping, or trucks and cars at a car wash. Be creative, but also allow children opportunities to gain experience and explore with sand and water. Emergency Preparedness and Response Plan Emergency Preparedness and Response in Child Care training must be completed by at least one staff member (usually the administrator) within one year of the effective date of the initial license. Maintain documentation of this training. Once the EPR training is completed, you must complete an EPR Plan on a template at the following website https://rmp.nc.gov/portal/portal.aspx within four (4) months. After you complete the Emergency Preparedness and Response in Child Care training, you must conduct either a shelter-in-place or a lockdown drill every three months. Use the Emergency Drill Log to document these drills as well as the fire drills. The form is located under the Provider Documents tab on the DCDEE website at www.ncchildcare.ncdhhs.gov. A summary of today’s visit was reviewed with and provided to Ms. Lewis. Ms. Lewis was given the opportunity to ask any questions. If you have any further questions about today’s visit, please contact Ms. Childress at tammy.childress@dhhs.nc.gov or by telephone at (336)317-6436. You may also contact the Licensing Supervisor, Pamela Hauser, at pamela.hauser@dhhs.nc.gov if you have concerns regarding today’s visit or any violations documented. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0605 · Violation

Name of Operation: THE NEST SCHOOL Facility ID: 34001399 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: Visit Date: 8/16/2023 Number Present: 40 Completed Date: 8/16/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 11:00 AM Time Out: 03:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time visit. The visit was conducted with Leanne Prince, Assistant Director, by Tammy Childress, Lead Child Care Consultant. Corrine Brylski, Regional Director, was also on-site for a portion of the visit. Currently this center operates with a Temporary License, issued on July 14, 2023, to operate first shift. The facility is licensed to provide care to children ages zero to twelve-years-old and is approved to operate eight classrooms within the building. Restrictions are daytime care only and children under 2 ½ years old in rooms with direct exits. The Secretary of State website was checked today, and the owner, The Nest Schools, Inc., is current on all required documents and active on the NC Business Registry. If any changes to the corporation need to be made or you decide to sale your business, then you must notify your consultant at least thirty days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location, or inherited. Four classrooms with children ages infant to four-years-old in operation were monitored during the visit. All program records, documents required to be posted, and a sampling of staff and children’s files were monitored. The outdoor learning environment was monitored today. The facility does not provide transportation. Meals and snacks are prepared at the facility and the children eat all food in the classrooms. During today’s visit children present were observed to be engaged in free choice activities, personal care routines and lunch. The following violations were cited during today’s visit: Violation Number Comment Rule 533 Breast milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. Three bottles for an enrolled infant were not dated. 15A NCAC 18A .2804(d) 847 Parent's medication authorization did not include required information. There was no medication permission form for a tube of Aquaphor diaper cream for an enrolled infant. 10A NCAC 09 .0803(4)(6-9) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A playground inspection was not documented for July, 2023. .0605(q) Two of the violations documented today were corrected during the visit. The parent of the child who had not dated the infant bottles and who had not provided medication administration paperwork for a diaper cream was contacted and scanned a completed and signed medication administration permission form and the staff member dated the infant bottles with today’s date. Ms. Brylski stated that they will also share again with the parent the requirements regarding medications and bottles. Please send documentation noting how one additional violation, a missed playground inspection for the one month of July, 2023, will not be repeated in the future. Document what the plan will be to insure compliance with the rule requirement. Send the documentation to Tammy Childress by email at tammy.childress@dhhs.nc.gov by August 30, 2023. Your compliance history affects the star rating. It is imperative that staff maintain compliance with child care rules and requirements at all times. Violations of child care requirements affect the facility’s compliance history. You must maintain a minimum compliance history of seventy-five (75) percent. During today’s visit we discussed the two-component rated license process to assist the administrator and owners in deciding if they wish to request a Rated License Assessment and an Environment Rating Scale Assessment in order to obtain a 3-5 star rated license. Begin reviewing the Early Childhood Environment Rating Scale (revised edition) booklets, visit the North Carolina Rated License Assessment Project website at www.ncrlap.org and contact your local resource and referral agency for additional resources and technical assistance. The NCRLAP website offers training and additional notes on topics such as activity areas, indoor and outdoor materials, daily schedules, sanitation, and interactions. The application for a Rated License and a request form for the Environment Rating Scale Assessment were emailed to Krista Lewis, Director, and Ms. Brylski during today’s visit. Please complete and return these forms to Ms. Childress by October 16, 2023. The type of Star Rated License issued to you program will result from the points earned in the Program Component (overall score from the ERS Assessments and meeting enhanced ratios and/or space requirements), Staff Education, and a Quality Point. Please ensure that all staff members have a WORKS Account and are updated with their correct educational information. The information on each staff member’s WORKS Qualification Letter and what is shown in the DCDEE WORKS system is what will be used to determine the points in education for your license. Instructions for the DCDEE WORKS system is located in the DCDEE website at https://ncchildcare.ncdhhs.gov. Technical Assistance and/or Consultation was provided during today’s visit on the following: Administering Medication It is recommended that medication permissions are placed with each medication. Medication administration forms and permissions must contain all required information and be completed in full by the parent. All medications must be labeled with the child’s name to whom it belongs. Child Care Rule 10A NCAC 09 .1803 The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician, or other health professional; (c) in any manner not authorized by the child's parent, physician, or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. Infant Nutrition Sanitation Rule 15A NCAC 18A .2804 FOOD SUPPLIES (d) Breast milk, formula, and other bottled beverages, including beverages in sippy cups, sent from home shall be fully prepared, dated, and identified for the appropriate child at the child's home. All breast milk, formula, and other bottled beverages shall be returned to the child's home or discarded at the end of each day. Frozen breast milk shall be stored frozen for up to seven days. Frozen breast milk shall be labeled with the date received and date thawed for use. Previously frozen breast milk shall be refrigerated and may be stored for no more than 24 hours. Microwaves shall not be used to thaw or warm breast milk, baby food, formula or other bottled beverages. Bottle warming equipment shall be inaccessible to children when in use and shall be emptied, cleaned and sanitized daily. Previously frozen breast milk shall not be refrozen for storage. Formula provided by the child care center shall be commercially pre-packaged, ready-to-feed, fully prepared, and packaged in single-use containers. However, breast milk or formula that does not meet these requirements may be provided by the child care center as prescribed by the child's physician or instructed by parent or guardian in writing. Bottles and other drinking utensils provided by the child care center shall be sanitized in accordance with this Section. Formula and other beverages which require refrigeration, baby food after opening, and breast milk shall be identified for the appropriate child and shall be refrigerated at 45°F (7°C) or below. Upon opening, jars of baby food shall be covered, dated, refrigerated, and used within two days. Baby food may be served directly from the jar to one child if unused portions of the food are discarded after each feeding; otherwise, commercially prepared baby foods shall be served from a serving dish rather than the food jar. After the completion of each feeding, leftover formula, breast milk, and other bottled beverages shall be discarded or returned to the child's home at the end of each day. Outdoor Learning Environments 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. Health and Safety Training Ensure that all staff complete the required Health and Safety trainings within one year of hire. These trainings can be accessed on the DCDEE website at https://ncchildcare.ncdhhs.gov under the Provider tab from the home screen, select Training and Professional Development, and finally DCDEE Moodle. If you need assistance in locating the trainings please contact me. It is important to remember that the child care administrator and all staff members must complete the specific Health and Safety Training called “Recognizing and Responding to Suspicions of Child Maltreatment”, within 90 days of employment. This training can be accessed through Moodle or directly at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. On-Going Professional Development If staff complete approved college courses in child development, for every one college credit hour (CEU) completed staff will earn 16 hours of on-going training. All staff must complete the required number of on-going training hours based upon education and experience within one year of hire and annually. The required number of training hours can be determined for each staff member using the information provided in Child Care Rule 10A NCAC 09 .1103. Register with Department of Justice You must register with the Department of Justice to receive e-mail or phone call notification if a sex offender moves into your area. To register, call 1-877-627-2826 or you may register on line at: http://sexoffender.ncdoj.gov/. To reference the law concerning Sex offender and Public Protection Registration Programs you may go to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_14/Article_27A.html. Contact the local Sheriff's Department if a sex offender email or phone notification is received from the NC Sex Offender Registry. Emergency Preparedness and Response Plan Emergency Preparedness and Response Training has been completed and you must complete an EPR Plan on a template at the following website https://rmp.nc.gov/portal/portal.aspx within four (4) months. A copy of the EPR plan must be printed and on file at the facility for review. After you complete the Emergency Preparedness and Response in Child Care training, you must conduct either a shelter-in-place or a lockdown drill every three months. Use the Emergency Drill Log to document these additional drills as well as the fire drills. The form is located under the Provider Documents tab on the DCDEE website at www.ncchildcare.ncdhhs.gov. The EPR Plan will be reviewed with all staff upon hire during orientation, whenever changes to the plan occur, and at least yearly. The date of the review of the plan with staff should be documented on the Staff and Training Worksheets. In addition, the administrator must review the plan annually in the portal and make updates if required. Once reviewed, print off the first page of the plan which will reflect the date of the review. A summary of today’s was reviewed with and provided to Ms. Prince and emailed to Ms. Brylski, and they were given the opportunity to ask any questions. If you have any further questions about today’s visit, please contact Ms. Childress at tammy.burcham@dhhs.nc.gov or by telephone at (336)317-6436. You may also contact the Licensing Supervisor, Pamela Hauser, at pamela.hauser@dhhs.nc.gov if you have concerns regarding today’s visit or any violations documented. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .0803 · Violation

Name of Operation: THE NEST SCHOOL Facility ID: 34001399 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: Visit Date: 8/16/2023 Number Present: 40 Completed Date: 8/16/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 11:00 AM Time Out: 03:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time visit. The visit was conducted with Leanne Prince, Assistant Director, by Tammy Childress, Lead Child Care Consultant. Corrine Brylski, Regional Director, was also on-site for a portion of the visit. Currently this center operates with a Temporary License, issued on July 14, 2023, to operate first shift. The facility is licensed to provide care to children ages zero to twelve-years-old and is approved to operate eight classrooms within the building. Restrictions are daytime care only and children under 2 ½ years old in rooms with direct exits. The Secretary of State website was checked today, and the owner, The Nest Schools, Inc., is current on all required documents and active on the NC Business Registry. If any changes to the corporation need to be made or you decide to sale your business, then you must notify your consultant at least thirty days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location, or inherited. Four classrooms with children ages infant to four-years-old in operation were monitored during the visit. All program records, documents required to be posted, and a sampling of staff and children’s files were monitored. The outdoor learning environment was monitored today. The facility does not provide transportation. Meals and snacks are prepared at the facility and the children eat all food in the classrooms. During today’s visit children present were observed to be engaged in free choice activities, personal care routines and lunch. The following violations were cited during today’s visit: Violation Number Comment Rule 533 Breast milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. Three bottles for an enrolled infant were not dated. 15A NCAC 18A .2804(d) 847 Parent's medication authorization did not include required information. There was no medication permission form for a tube of Aquaphor diaper cream for an enrolled infant. 10A NCAC 09 .0803(4)(6-9) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A playground inspection was not documented for July, 2023. .0605(q) Two of the violations documented today were corrected during the visit. The parent of the child who had not dated the infant bottles and who had not provided medication administration paperwork for a diaper cream was contacted and scanned a completed and signed medication administration permission form and the staff member dated the infant bottles with today’s date. Ms. Brylski stated that they will also share again with the parent the requirements regarding medications and bottles. Please send documentation noting how one additional violation, a missed playground inspection for the one month of July, 2023, will not be repeated in the future. Document what the plan will be to insure compliance with the rule requirement. Send the documentation to Tammy Childress by email at tammy.childress@dhhs.nc.gov by August 30, 2023. Your compliance history affects the star rating. It is imperative that staff maintain compliance with child care rules and requirements at all times. Violations of child care requirements affect the facility’s compliance history. You must maintain a minimum compliance history of seventy-five (75) percent. During today’s visit we discussed the two-component rated license process to assist the administrator and owners in deciding if they wish to request a Rated License Assessment and an Environment Rating Scale Assessment in order to obtain a 3-5 star rated license. Begin reviewing the Early Childhood Environment Rating Scale (revised edition) booklets, visit the North Carolina Rated License Assessment Project website at www.ncrlap.org and contact your local resource and referral agency for additional resources and technical assistance. The NCRLAP website offers training and additional notes on topics such as activity areas, indoor and outdoor materials, daily schedules, sanitation, and interactions. The application for a Rated License and a request form for the Environment Rating Scale Assessment were emailed to Krista Lewis, Director, and Ms. Brylski during today’s visit. Please complete and return these forms to Ms. Childress by October 16, 2023. The type of Star Rated License issued to you program will result from the points earned in the Program Component (overall score from the ERS Assessments and meeting enhanced ratios and/or space requirements), Staff Education, and a Quality Point. Please ensure that all staff members have a WORKS Account and are updated with their correct educational information. The information on each staff member’s WORKS Qualification Letter and what is shown in the DCDEE WORKS system is what will be used to determine the points in education for your license. Instructions for the DCDEE WORKS system is located in the DCDEE website at https://ncchildcare.ncdhhs.gov. Technical Assistance and/or Consultation was provided during today’s visit on the following: Administering Medication It is recommended that medication permissions are placed with each medication. Medication administration forms and permissions must contain all required information and be completed in full by the parent. All medications must be labeled with the child’s name to whom it belongs. Child Care Rule 10A NCAC 09 .1803 The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician, or other health professional; (c) in any manner not authorized by the child's parent, physician, or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. Infant Nutrition Sanitation Rule 15A NCAC 18A .2804 FOOD SUPPLIES (d) Breast milk, formula, and other bottled beverages, including beverages in sippy cups, sent from home shall be fully prepared, dated, and identified for the appropriate child at the child's home. All breast milk, formula, and other bottled beverages shall be returned to the child's home or discarded at the end of each day. Frozen breast milk shall be stored frozen for up to seven days. Frozen breast milk shall be labeled with the date received and date thawed for use. Previously frozen breast milk shall be refrigerated and may be stored for no more than 24 hours. Microwaves shall not be used to thaw or warm breast milk, baby food, formula or other bottled beverages. Bottle warming equipment shall be inaccessible to children when in use and shall be emptied, cleaned and sanitized daily. Previously frozen breast milk shall not be refrozen for storage. Formula provided by the child care center shall be commercially pre-packaged, ready-to-feed, fully prepared, and packaged in single-use containers. However, breast milk or formula that does not meet these requirements may be provided by the child care center as prescribed by the child's physician or instructed by parent or guardian in writing. Bottles and other drinking utensils provided by the child care center shall be sanitized in accordance with this Section. Formula and other beverages which require refrigeration, baby food after opening, and breast milk shall be identified for the appropriate child and shall be refrigerated at 45°F (7°C) or below. Upon opening, jars of baby food shall be covered, dated, refrigerated, and used within two days. Baby food may be served directly from the jar to one child if unused portions of the food are discarded after each feeding; otherwise, commercially prepared baby foods shall be served from a serving dish rather than the food jar. After the completion of each feeding, leftover formula, breast milk, and other bottled beverages shall be discarded or returned to the child's home at the end of each day. Outdoor Learning Environments 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. Health and Safety Training Ensure that all staff complete the required Health and Safety trainings within one year of hire. These trainings can be accessed on the DCDEE website at https://ncchildcare.ncdhhs.gov under the Provider tab from the home screen, select Training and Professional Development, and finally DCDEE Moodle. If you need assistance in locating the trainings please contact me. It is important to remember that the child care administrator and all staff members must complete the specific Health and Safety Training called “Recognizing and Responding to Suspicions of Child Maltreatment”, within 90 days of employment. This training can be accessed through Moodle or directly at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. On-Going Professional Development If staff complete approved college courses in child development, for every one college credit hour (CEU) completed staff will earn 16 hours of on-going training. All staff must complete the required number of on-going training hours based upon education and experience within one year of hire and annually. The required number of training hours can be determined for each staff member using the information provided in Child Care Rule 10A NCAC 09 .1103. Register with Department of Justice You must register with the Department of Justice to receive e-mail or phone call notification if a sex offender moves into your area. To register, call 1-877-627-2826 or you may register on line at: http://sexoffender.ncdoj.gov/. To reference the law concerning Sex offender and Public Protection Registration Programs you may go to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_14/Article_27A.html. Contact the local Sheriff's Department if a sex offender email or phone notification is received from the NC Sex Offender Registry. Emergency Preparedness and Response Plan Emergency Preparedness and Response Training has been completed and you must complete an EPR Plan on a template at the following website https://rmp.nc.gov/portal/portal.aspx within four (4) months. A copy of the EPR plan must be printed and on file at the facility for review. After you complete the Emergency Preparedness and Response in Child Care training, you must conduct either a shelter-in-place or a lockdown drill every three months. Use the Emergency Drill Log to document these additional drills as well as the fire drills. The form is located under the Provider Documents tab on the DCDEE website at www.ncchildcare.ncdhhs.gov. The EPR Plan will be reviewed with all staff upon hire during orientation, whenever changes to the plan occur, and at least yearly. The date of the review of the plan with staff should be documented on the Staff and Training Worksheets. In addition, the administrator must review the plan annually in the portal and make updates if required. Once reviewed, print off the first page of the plan which will reflect the date of the review. A summary of today’s was reviewed with and provided to Ms. Prince and emailed to Ms. Brylski, and they were given the opportunity to ask any questions. If you have any further questions about today’s visit, please contact Ms. Childress at tammy.burcham@dhhs.nc.gov or by telephone at (336)317-6436. You may also contact the Licensing Supervisor, Pamela Hauser, at pamela.hauser@dhhs.nc.gov if you have concerns regarding today’s visit or any violations documented. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1103 · Violation

Name of Operation: THE NEST SCHOOL Facility ID: 34001399 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: Visit Date: 8/16/2023 Number Present: 40 Completed Date: 8/16/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 11:00 AM Time Out: 03:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time visit. The visit was conducted with Leanne Prince, Assistant Director, by Tammy Childress, Lead Child Care Consultant. Corrine Brylski, Regional Director, was also on-site for a portion of the visit. Currently this center operates with a Temporary License, issued on July 14, 2023, to operate first shift. The facility is licensed to provide care to children ages zero to twelve-years-old and is approved to operate eight classrooms within the building. Restrictions are daytime care only and children under 2 ½ years old in rooms with direct exits. The Secretary of State website was checked today, and the owner, The Nest Schools, Inc., is current on all required documents and active on the NC Business Registry. If any changes to the corporation need to be made or you decide to sale your business, then you must notify your consultant at least thirty days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location, or inherited. Four classrooms with children ages infant to four-years-old in operation were monitored during the visit. All program records, documents required to be posted, and a sampling of staff and children’s files were monitored. The outdoor learning environment was monitored today. The facility does not provide transportation. Meals and snacks are prepared at the facility and the children eat all food in the classrooms. During today’s visit children present were observed to be engaged in free choice activities, personal care routines and lunch. The following violations were cited during today’s visit: Violation Number Comment Rule 533 Breast milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. Three bottles for an enrolled infant were not dated. 15A NCAC 18A .2804(d) 847 Parent's medication authorization did not include required information. There was no medication permission form for a tube of Aquaphor diaper cream for an enrolled infant. 10A NCAC 09 .0803(4)(6-9) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A playground inspection was not documented for July, 2023. .0605(q) Two of the violations documented today were corrected during the visit. The parent of the child who had not dated the infant bottles and who had not provided medication administration paperwork for a diaper cream was contacted and scanned a completed and signed medication administration permission form and the staff member dated the infant bottles with today’s date. Ms. Brylski stated that they will also share again with the parent the requirements regarding medications and bottles. Please send documentation noting how one additional violation, a missed playground inspection for the one month of July, 2023, will not be repeated in the future. Document what the plan will be to insure compliance with the rule requirement. Send the documentation to Tammy Childress by email at tammy.childress@dhhs.nc.gov by August 30, 2023. Your compliance history affects the star rating. It is imperative that staff maintain compliance with child care rules and requirements at all times. Violations of child care requirements affect the facility’s compliance history. You must maintain a minimum compliance history of seventy-five (75) percent. During today’s visit we discussed the two-component rated license process to assist the administrator and owners in deciding if they wish to request a Rated License Assessment and an Environment Rating Scale Assessment in order to obtain a 3-5 star rated license. Begin reviewing the Early Childhood Environment Rating Scale (revised edition) booklets, visit the North Carolina Rated License Assessment Project website at www.ncrlap.org and contact your local resource and referral agency for additional resources and technical assistance. The NCRLAP website offers training and additional notes on topics such as activity areas, indoor and outdoor materials, daily schedules, sanitation, and interactions. The application for a Rated License and a request form for the Environment Rating Scale Assessment were emailed to Krista Lewis, Director, and Ms. Brylski during today’s visit. Please complete and return these forms to Ms. Childress by October 16, 2023. The type of Star Rated License issued to you program will result from the points earned in the Program Component (overall score from the ERS Assessments and meeting enhanced ratios and/or space requirements), Staff Education, and a Quality Point. Please ensure that all staff members have a WORKS Account and are updated with their correct educational information. The information on each staff member’s WORKS Qualification Letter and what is shown in the DCDEE WORKS system is what will be used to determine the points in education for your license. Instructions for the DCDEE WORKS system is located in the DCDEE website at https://ncchildcare.ncdhhs.gov. Technical Assistance and/or Consultation was provided during today’s visit on the following: Administering Medication It is recommended that medication permissions are placed with each medication. Medication administration forms and permissions must contain all required information and be completed in full by the parent. All medications must be labeled with the child’s name to whom it belongs. Child Care Rule 10A NCAC 09 .1803 The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician, or other health professional; (c) in any manner not authorized by the child's parent, physician, or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. Infant Nutrition Sanitation Rule 15A NCAC 18A .2804 FOOD SUPPLIES (d) Breast milk, formula, and other bottled beverages, including beverages in sippy cups, sent from home shall be fully prepared, dated, and identified for the appropriate child at the child's home. All breast milk, formula, and other bottled beverages shall be returned to the child's home or discarded at the end of each day. Frozen breast milk shall be stored frozen for up to seven days. Frozen breast milk shall be labeled with the date received and date thawed for use. Previously frozen breast milk shall be refrigerated and may be stored for no more than 24 hours. Microwaves shall not be used to thaw or warm breast milk, baby food, formula or other bottled beverages. Bottle warming equipment shall be inaccessible to children when in use and shall be emptied, cleaned and sanitized daily. Previously frozen breast milk shall not be refrozen for storage. Formula provided by the child care center shall be commercially pre-packaged, ready-to-feed, fully prepared, and packaged in single-use containers. However, breast milk or formula that does not meet these requirements may be provided by the child care center as prescribed by the child's physician or instructed by parent or guardian in writing. Bottles and other drinking utensils provided by the child care center shall be sanitized in accordance with this Section. Formula and other beverages which require refrigeration, baby food after opening, and breast milk shall be identified for the appropriate child and shall be refrigerated at 45°F (7°C) or below. Upon opening, jars of baby food shall be covered, dated, refrigerated, and used within two days. Baby food may be served directly from the jar to one child if unused portions of the food are discarded after each feeding; otherwise, commercially prepared baby foods shall be served from a serving dish rather than the food jar. After the completion of each feeding, leftover formula, breast milk, and other bottled beverages shall be discarded or returned to the child's home at the end of each day. Outdoor Learning Environments 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. Health and Safety Training Ensure that all staff complete the required Health and Safety trainings within one year of hire. These trainings can be accessed on the DCDEE website at https://ncchildcare.ncdhhs.gov under the Provider tab from the home screen, select Training and Professional Development, and finally DCDEE Moodle. If you need assistance in locating the trainings please contact me. It is important to remember that the child care administrator and all staff members must complete the specific Health and Safety Training called “Recognizing and Responding to Suspicions of Child Maltreatment”, within 90 days of employment. This training can be accessed through Moodle or directly at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. On-Going Professional Development If staff complete approved college courses in child development, for every one college credit hour (CEU) completed staff will earn 16 hours of on-going training. All staff must complete the required number of on-going training hours based upon education and experience within one year of hire and annually. The required number of training hours can be determined for each staff member using the information provided in Child Care Rule 10A NCAC 09 .1103. Register with Department of Justice You must register with the Department of Justice to receive e-mail or phone call notification if a sex offender moves into your area. To register, call 1-877-627-2826 or you may register on line at: http://sexoffender.ncdoj.gov/. To reference the law concerning Sex offender and Public Protection Registration Programs you may go to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_14/Article_27A.html. Contact the local Sheriff's Department if a sex offender email or phone notification is received from the NC Sex Offender Registry. Emergency Preparedness and Response Plan Emergency Preparedness and Response Training has been completed and you must complete an EPR Plan on a template at the following website https://rmp.nc.gov/portal/portal.aspx within four (4) months. A copy of the EPR plan must be printed and on file at the facility for review. After you complete the Emergency Preparedness and Response in Child Care training, you must conduct either a shelter-in-place or a lockdown drill every three months. Use the Emergency Drill Log to document these additional drills as well as the fire drills. The form is located under the Provider Documents tab on the DCDEE website at www.ncchildcare.ncdhhs.gov. The EPR Plan will be reviewed with all staff upon hire during orientation, whenever changes to the plan occur, and at least yearly. The date of the review of the plan with staff should be documented on the Staff and Training Worksheets. In addition, the administrator must review the plan annually in the portal and make updates if required. Once reviewed, print off the first page of the plan which will reflect the date of the review. A summary of today’s was reviewed with and provided to Ms. Prince and emailed to Ms. Brylski, and they were given the opportunity to ask any questions. If you have any further questions about today’s visit, please contact Ms. Childress at tammy.burcham@dhhs.nc.gov or by telephone at (336)317-6436. You may also contact the Licensing Supervisor, Pamela Hauser, at pamela.hauser@dhhs.nc.gov if you have concerns regarding today’s visit or any violations documented. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1803 · Violation

Name of Operation: THE NEST SCHOOL Facility ID: 34001399 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: Visit Date: 8/16/2023 Number Present: 40 Completed Date: 8/16/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 11:00 AM Time Out: 03:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time visit. The visit was conducted with Leanne Prince, Assistant Director, by Tammy Childress, Lead Child Care Consultant. Corrine Brylski, Regional Director, was also on-site for a portion of the visit. Currently this center operates with a Temporary License, issued on July 14, 2023, to operate first shift. The facility is licensed to provide care to children ages zero to twelve-years-old and is approved to operate eight classrooms within the building. Restrictions are daytime care only and children under 2 ½ years old in rooms with direct exits. The Secretary of State website was checked today, and the owner, The Nest Schools, Inc., is current on all required documents and active on the NC Business Registry. If any changes to the corporation need to be made or you decide to sale your business, then you must notify your consultant at least thirty days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location, or inherited. Four classrooms with children ages infant to four-years-old in operation were monitored during the visit. All program records, documents required to be posted, and a sampling of staff and children’s files were monitored. The outdoor learning environment was monitored today. The facility does not provide transportation. Meals and snacks are prepared at the facility and the children eat all food in the classrooms. During today’s visit children present were observed to be engaged in free choice activities, personal care routines and lunch. The following violations were cited during today’s visit: Violation Number Comment Rule 533 Breast milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. Three bottles for an enrolled infant were not dated. 15A NCAC 18A .2804(d) 847 Parent's medication authorization did not include required information. There was no medication permission form for a tube of Aquaphor diaper cream for an enrolled infant. 10A NCAC 09 .0803(4)(6-9) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A playground inspection was not documented for July, 2023. .0605(q) Two of the violations documented today were corrected during the visit. The parent of the child who had not dated the infant bottles and who had not provided medication administration paperwork for a diaper cream was contacted and scanned a completed and signed medication administration permission form and the staff member dated the infant bottles with today’s date. Ms. Brylski stated that they will also share again with the parent the requirements regarding medications and bottles. Please send documentation noting how one additional violation, a missed playground inspection for the one month of July, 2023, will not be repeated in the future. Document what the plan will be to insure compliance with the rule requirement. Send the documentation to Tammy Childress by email at tammy.childress@dhhs.nc.gov by August 30, 2023. Your compliance history affects the star rating. It is imperative that staff maintain compliance with child care rules and requirements at all times. Violations of child care requirements affect the facility’s compliance history. You must maintain a minimum compliance history of seventy-five (75) percent. During today’s visit we discussed the two-component rated license process to assist the administrator and owners in deciding if they wish to request a Rated License Assessment and an Environment Rating Scale Assessment in order to obtain a 3-5 star rated license. Begin reviewing the Early Childhood Environment Rating Scale (revised edition) booklets, visit the North Carolina Rated License Assessment Project website at www.ncrlap.org and contact your local resource and referral agency for additional resources and technical assistance. The NCRLAP website offers training and additional notes on topics such as activity areas, indoor and outdoor materials, daily schedules, sanitation, and interactions. The application for a Rated License and a request form for the Environment Rating Scale Assessment were emailed to Krista Lewis, Director, and Ms. Brylski during today’s visit. Please complete and return these forms to Ms. Childress by October 16, 2023. The type of Star Rated License issued to you program will result from the points earned in the Program Component (overall score from the ERS Assessments and meeting enhanced ratios and/or space requirements), Staff Education, and a Quality Point. Please ensure that all staff members have a WORKS Account and are updated with their correct educational information. The information on each staff member’s WORKS Qualification Letter and what is shown in the DCDEE WORKS system is what will be used to determine the points in education for your license. Instructions for the DCDEE WORKS system is located in the DCDEE website at https://ncchildcare.ncdhhs.gov. Technical Assistance and/or Consultation was provided during today’s visit on the following: Administering Medication It is recommended that medication permissions are placed with each medication. Medication administration forms and permissions must contain all required information and be completed in full by the parent. All medications must be labeled with the child’s name to whom it belongs. Child Care Rule 10A NCAC 09 .1803 The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician, or other health professional; (c) in any manner not authorized by the child's parent, physician, or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. Infant Nutrition Sanitation Rule 15A NCAC 18A .2804 FOOD SUPPLIES (d) Breast milk, formula, and other bottled beverages, including beverages in sippy cups, sent from home shall be fully prepared, dated, and identified for the appropriate child at the child's home. All breast milk, formula, and other bottled beverages shall be returned to the child's home or discarded at the end of each day. Frozen breast milk shall be stored frozen for up to seven days. Frozen breast milk shall be labeled with the date received and date thawed for use. Previously frozen breast milk shall be refrigerated and may be stored for no more than 24 hours. Microwaves shall not be used to thaw or warm breast milk, baby food, formula or other bottled beverages. Bottle warming equipment shall be inaccessible to children when in use and shall be emptied, cleaned and sanitized daily. Previously frozen breast milk shall not be refrozen for storage. Formula provided by the child care center shall be commercially pre-packaged, ready-to-feed, fully prepared, and packaged in single-use containers. However, breast milk or formula that does not meet these requirements may be provided by the child care center as prescribed by the child's physician or instructed by parent or guardian in writing. Bottles and other drinking utensils provided by the child care center shall be sanitized in accordance with this Section. Formula and other beverages which require refrigeration, baby food after opening, and breast milk shall be identified for the appropriate child and shall be refrigerated at 45°F (7°C) or below. Upon opening, jars of baby food shall be covered, dated, refrigerated, and used within two days. Baby food may be served directly from the jar to one child if unused portions of the food are discarded after each feeding; otherwise, commercially prepared baby foods shall be served from a serving dish rather than the food jar. After the completion of each feeding, leftover formula, breast milk, and other bottled beverages shall be discarded or returned to the child's home at the end of each day. Outdoor Learning Environments 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. Health and Safety Training Ensure that all staff complete the required Health and Safety trainings within one year of hire. These trainings can be accessed on the DCDEE website at https://ncchildcare.ncdhhs.gov under the Provider tab from the home screen, select Training and Professional Development, and finally DCDEE Moodle. If you need assistance in locating the trainings please contact me. It is important to remember that the child care administrator and all staff members must complete the specific Health and Safety Training called “Recognizing and Responding to Suspicions of Child Maltreatment”, within 90 days of employment. This training can be accessed through Moodle or directly at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. On-Going Professional Development If staff complete approved college courses in child development, for every one college credit hour (CEU) completed staff will earn 16 hours of on-going training. All staff must complete the required number of on-going training hours based upon education and experience within one year of hire and annually. The required number of training hours can be determined for each staff member using the information provided in Child Care Rule 10A NCAC 09 .1103. Register with Department of Justice You must register with the Department of Justice to receive e-mail or phone call notification if a sex offender moves into your area. To register, call 1-877-627-2826 or you may register on line at: http://sexoffender.ncdoj.gov/. To reference the law concerning Sex offender and Public Protection Registration Programs you may go to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_14/Article_27A.html. Contact the local Sheriff's Department if a sex offender email or phone notification is received from the NC Sex Offender Registry. Emergency Preparedness and Response Plan Emergency Preparedness and Response Training has been completed and you must complete an EPR Plan on a template at the following website https://rmp.nc.gov/portal/portal.aspx within four (4) months. A copy of the EPR plan must be printed and on file at the facility for review. After you complete the Emergency Preparedness and Response in Child Care training, you must conduct either a shelter-in-place or a lockdown drill every three months. Use the Emergency Drill Log to document these additional drills as well as the fire drills. The form is located under the Provider Documents tab on the DCDEE website at www.ncchildcare.ncdhhs.gov. The EPR Plan will be reviewed with all staff upon hire during orientation, whenever changes to the plan occur, and at least yearly. The date of the review of the plan with staff should be documented on the Staff and Training Worksheets. In addition, the administrator must review the plan annually in the portal and make updates if required. Once reviewed, print off the first page of the plan which will reflect the date of the review. A summary of today’s was reviewed with and provided to Ms. Prince and emailed to Ms. Brylski, and they were given the opportunity to ask any questions. If you have any further questions about today’s visit, please contact Ms. Childress at tammy.burcham@dhhs.nc.gov or by telephone at (336)317-6436. You may also contact the Licensing Supervisor, Pamela Hauser, at pamela.hauser@dhhs.nc.gov if you have concerns regarding today’s visit or any violations documented. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times