CHILDCARE NETWORK #54

15A NCAC 18A .2806 (d) Bulk food stored in a refrigerator shall be stored in the child care center's kitchen or in an approved food preparation area equipped with a full-size refrigerator. Observed bulk sized simalac milk stored in dorm sized refrigerator in infant classroom. -General comment.

15A NCAC 18A .2817 (a. All toilet fixtures shall be kept clean and in good repair. Observed general cleaning needed to outside corners of toilets located in hallway restrooms.

15A NCAC 18A .2819 (d) Use approved diapering methods as follows: 1) gather supplies, 2) wear disposable gloves (if needed), 3) use a disposable moist towelette to clean child, wiping front to back, 4) dispose of gloves if used and soiled towelettes, 5) wiping the employee's hands and the child's hands with a separate disposable towelette, 6) slide clean diaper under child and apply diapering products if needed using approved methods, 7) fasten diaper and place clothing on child, 8) wash child's hands, 9) and 10) clean and disinfect diapering surface using approved methods, 11) employee washes their hands. Observed teacher miss strep 4 and 5 in diaper changing procedure in infant classroom.

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. Observed some cribs in infant classroom not labeled for individual children. -General comment.

15A NCAC 18A .2822 (a) Toys, equipment, furniture, and any other items accessible to the children shall be kept clean and in good repair. Observed some books and in need of replacing in classrooms throughout center.

15A NCAC 18A .2832 (a). Child care center premises, including the outdoor learning environment, shall be kept clean, drained to minimize standing water, free of litter and hazards, and maintained in a manner which does not create conditions that attract or harbor pests. Observed a couple of outside toys/buckets filled with water. Observed dilapidated furniture, litter, and cardboard boxes stored within dumpster enclosure area.

15A NCAC 18A .2806 (d) Bulk food stored in a refrigerator shall be stored in the child care center's kitchen or in an approved food preparation area equipped with a full-size refrigerator. 15A NCAC 18A .2806 (d) Specialty bulk milk that is sent from home for consumption by a child while at the child care center may be stored as set forth in the 2800 rules when the child's parent or guardian provides written permission and the specialty bulk milk is sent to the child care center at the beginning of each week unopened, labeled with the date received by the child care center, and labeled with the name of the child to whom the bulk specialty milk belongs. Any remaining bulk specialty milk shall be sent home at the end of the week with the child to whom the bulk specialty milk belongs. Observed 2 containers of speciality milk stored in dorm sized refrigerator in infant classroom. EHS educated center on notated rule. -General comment.

15A NCAC 18A .2815 (e) Hot water shall be maintained between 80°F and 110°F at handwashing sinks accessible to children. Observed hot water ranging between 72F-78F in areas accessible to children throughout center.

15A NCAC 18A .2817 (a. All toilet fixtures shall be kept clean and in good repair. Observed detailed cleaning needed to outside portions of toilets located in hallway group restrooms.

15A NCAC 18A .2818 (e) Handwash signs shall be posted at every handwash lavatory area. The signs shall instruct children and child care center employees to wash their hands in accordance with Rule .2803. Observed no handwashing sign posted at handsink located near main door in infant classroom. -General comment.

15A NCAC 18A .2830 (c) Dumpsters and other containerized systems shall be kept clean and covered. Observed 1 sliding door opened to dumpster. -General comment.

15A NCAC 18A .2831 (b). (b) Pests shall be excluded from the child care center. Traps set for pests shall only be placed in areas that are inaccessible to children. Observed several drain flies in after school classroom.

15A NCAC 18A .2806 (h) The temperature of potentially hazardous food provided by the child care center for consumption by children shall be 45 degrees Fahrenheit or below, or at 135 degrees Fahrenheit or above at all times, including field trips, catering events, and outdoor service, except during periods of preparation and service immediately prior to consumption. Observed turkey packets on counter at 68F. Lunch was 2 hours away. Do not pull food out of cooler until ready for preparation. If another task is required put food back into cooler until ready to complete food prep.

15A NCAC 18A .2812 (h) After sanitizing, all equipment and utensils shall be air dried. Observed items being wiped dry with towel. Air dry only

15A NCAC 18A .2819 (d) Use approved diapering methods as follows: 1) gather supplies, 2) wear disposable gloves (if needed), 3) use a disposable moist towelette to clean child, wiping front to back, 4) dispose of gloves if used and soiled towelettes, 5) wiping the employee's hands and the child's hands with a separate disposable towelette, 6) slide clean diaper under child and apply diapering products if needed using approved methods, 7) fasten diaper and place clothing on child, 8) wash child's hands, 9) and 10) clean and disinfect diapering surface using approved methods, 11) employee washes their hands. Repeat- Observed incorrect diaper changes in 2’s classroom. Staff kept the dirty gloves on until after the child was dressed. Disinfect needs to be misted on for complete disinfection of the table surface. Do not store extra supplies on changing table. Follow posted procedures

15A NCAC 18A .2820 (c). Non-aerosol sanitizing solutions, approved disinfectants, detergent solutions, hand antiseptics, and hand lotions shall be kept inaccessible to children when not in use by storing the items 5 ft above the floor or behind lock and key. Observed hand sanitizer stored <5 feet above floor in 1 classroom.

15A NCAC 18A .2820 (a). Adequate space shall be provided for the storage of equipment, furniture, toys, clothes, linens, backpacks, book bags, diaper bags, beds, cots, mats, and supplies, and shall be kept clean. Repeat-Observed overstuffed storage areas in after school 2 . These areas need organizing and discarded/relocating of excess items. 15A NCAC 18A .2820 (g).Purses, that do not contain hazardous items, must be stored 5 ft above the floor, behind lock and key, or behind a child safety lock. Repeat-Observed purse not 5 feet above floor in 1 classroom

15A NCAC 18A .2822 (a) Toys, equipment, furniture, and any other items accessible to the children shall be kept clean and in good repair. Repeat-Observed shelving units, book cases, and cubby bins with debris or tape residue.

15A NCAC 18A .2830 (d) Solid wastes shall be disposed of to prevent conditions that attract and harbor pests and other public health nuisances. Observed a small amount of trash and foam wall boards on ground in dumpster corral.

15A NCAC 18A .2831 (b). (b) Pests shall be excluded from the child care center. Traps set for pests shall only be placed in areas that are inaccessible to children. Repeat-Observed rodent droppings in after school classroom 2. Room is very cluttered, cleaning storage areas very difficult. 15A NCAC 18A .2831 (c) All openings to the area outside of the child care center shall be protected against the entrance of pests. Observed broken dryer vent on outside of building. Replace with intact cover to prevent animal access to inside building.

5A NCAC 18A .2831 (c). For outdoor toys and play equipment, including all structures accessible to children, the following shall apply: (1) Equipment and toys shall be kept clean, in good repair, and free of peeling, flaking, or chalking paint, rust, and corrosion; and (2) A sandbox used in outdoor play shall be constructed to allow for drainage of water and shall be covered when not in use and kept clean. Observed an exposed spike securing landscape timbers around play structure. Stairs to climber, protective coating split, rusted metal inside is sharp.

15A NCAC 18A.2803 (e). Handwashing procedures shall include: (1) using liquid soap and tempered water; (2) rubbing hands vigorously with soap and tempered water for 15 seconds; (3) washing all surfaces of the hands, to include the backs of hands, palms, wrists, under fingernails and between fingers; (4) rinsing the hands under tempered water for 10 seconds; (5) drying hands with a paper towel or other hand-drying device; and (6) turning off faucet with a paper towel or other method without recontaminating hands. Observed staff turning off water with hand and touching garbage can lid with hand.

15A NCAC 18A .2809 (3) Other surfaces that do not come into contact with food shall be made of nonabsorbent material and shall be kept clean and in good repair. Repeat- Observed 3-comp sink with square corners and sealant is mushy and water-logged, needs replacing.

15A NCAC 18A .2817 (a. All toilet fixtures shall be kept clean and in good repair. Observed toilet seat with damaged surface needs replacement. Paint or seal edge of vanity in toddler’s class. 15A NCAC 18A .2818 (c) Lavatories shall be cleaned and disinfected with each change of use, when visibly soiled, and at least daily. Change of use occurs when a handwash lavatory is used outside of its original intent. Observed disinfectant immediately wiped off after a change of use, toddler room.

15A NCAC 18A .2819 (d) Use approved diapering methods as follows: 1) gather supplies, 2) wear disposable gloves (if needed), 3) use a disposable moist towelette to clean child, wiping front to back, 4) dispose of gloves if used and soiled towelettes, 5) wiping the employee's hands and the child's hands with a separate disposable towelette, 6) slide clean diaper under child and apply diapering products if needed using approved methods, 7) fasten diaper and place clothing on child, 8) wash child's hands, 9) and 10) clean and disinfect diapering surface using approved methods, 11) employee washes their hands. Repeat- Observed incorrect diaper changes in both infant and toddler rooms. Both rooms kept the dirty gloves on until after the child was dressed. Follow posted procedures

15A NCAC 18A .2822 (a) Toys, equipment, furniture, and any other items accessible to the children shall be kept clean and in good repair. Repeat-Observed toys, containers, shelving units, book cases, and cubby bins with debris or tape residue.

15A NCAC 18A .2825 (a) In child care centers, the walls and ceilings, including doors and windows, of all rooms and areas, shall be kept clean, free of visible fungal growth, and in good repair. All walls and ceilings shall be free of peeling, flaking, chalking, or otherwise deteriorating paint. Repeat- Observed touch up paint needed throughout. Replace ceiling tiles where damaged/stained. Appearance of teeth marks on window sill in 4’s class. Lead swab showed negative.

15A NCAC 18A .2826 (a). Shielded or shatterproof bulbs shall be used in food preparation, storage, and serving areas and in all rooms used by children. Repeat-Observed lights not shielded or shatterproof in 4’s classroom.

15A NCAC 18A .2831 (b). (b) Pests shall be excluded from the child care center. Traps set for pests shall only be placed in areas that are inaccessible to children. Repeat-Observed rodent droppings in after school classroom, infant classroom, and hall closet.

15A NCAC 18A .2806 (f) Food and containers of food shall not be stored under exposed sewer lines. Food shall not be stored in toilet or laundry rooms, except that child care centers licensed for fewer than 13 children and located in a residence may store food in laundry rooms if the food is stored and protected as required in rule 2806 (g). Observed food stored below hand sink plumbing in infant room.

15A NCAC 18A .2809 (3) Other surfaces that do not come into contact with food shall be made of nonabsorbent material and shall be kept clean and in good repair. Observed 3-comp sink with square corners and sealant is mushy and water-logged, needs replacing.

15A NCAC 18A .2809 (3) Other surfaces that do not come into contact with food shall be kept clean and in good repair. Observed spill in milk cooler and food splatter in microwave. Keep clean

15A NCAC 18A .2814 (b) Cleaned and sanitized utensils and equipment shall be stored above the floor in a clean, dry location and shall be kept clean while stored. The food-contact surfaces of fixed equipment shall be kept clean while stored or otherwise not in use. Equipment and utensils shall not be stored under exposed sewer lines. Observed single service stored below hand sink in infant room and stored unprotected in several other rooms. Protect from contamination

15A NCAC 18A .2815 (e) Hot water that exceeds 120 degrees Fahrenheit is a burn hazard and shall not be provided in areas accessible to children. Observed can wash gate not secured, water >120F

15A NCAC 18A .2815 (c). A child care center's water supply plumbing shall not include cross-connections as set out in 15A NCAC 18C .0102(c)(8). If the potential for back siphonage or backflow conditions exist, an atmospheric vacuum breaker or backflow prevention device shall be installed. Observed no backflow preventers on outside faucets

15A NCAC 18A .2817 (a. All toilet fixtures shall be kept clean and in good repair. Observed leak at ring seal of toilet in boy’s bathroom. One toilet seat with surface damage needs replacing. 15A NCAC 18A .2818 (a). Lavatories shall be kept clean and in good repair. Observed sinks with rust around overflow drain, and build-up around fixtures.

15A NCAC 18A .2820 (d).Medications, including prescription and non-prescription items, shall be stored in a locked cabinet or other locked container and shall not be stored above food. Observed aspirin (toddler’s), liniment gel (4’s), unlocked in classrooms. Liniment was in a teacher’s backpack on a chair with labeling on the front reading medicine. Reminder-all hazardous items and medications must be locked up regardless of who brought them in.

15A NCAC 18A .2820 (c). Non-aerosol sanitizing solutions, approved disinfectants, detergent solutions, hand antiseptics, and hand lotions shall be kept inaccessible to children when not in use by storing the items 5 ft above the floor or behind lock and key. Observed hand lotion, lip balm, hand sanitizer, coagulant for vomit cleanup stored less than 5 feet above the floor.

15A NCAC 18A .2820 (a). Adequate space shall be provided for the storage of equipment, furniture, toys, clothes, linens, backpacks, book bags, diaper bags, beds, cots, mats, and supplies, and shall be kept clean. Observed overstuffed storage areas at end of hall and after school 2. These areas need organizing and discarded/relocating of excess items. 15A NCAC 18A .2820 (g).Purses, that do not contain hazardous items, must be stored 5 ft above the floor, behind lock and key, or behind a child safety lock. Observed purse not 5 feet above floor in 4’s room

15A NCAC 18A .2821 (e). When in use, cribs, cots, mats and play pens shall be placed at least 18 inches apart or separated by partitions that prevent physical contact between children. Observed cots placed < 18 inches apart in 2 classrooms.

15A NCAC 18A .2822 (a) Toys, equipment, furniture, and any other items accessible to the children shall be kept clean and in good repair. Repeat-Observed toys, containers, shelving units, book cases, and cubby bins with debris or tape residue.

15A NCAC 18A .2822 (a). In rooms designated for children who are not toilet trained, toys and other mouth-contact surfaces that are used by children shall be cleaned and then sanitized after each use and when visibly dirty. Toys and other mouth-contact surfaces shall be cleaned and sanitized as follows: (1) the items shall be scrubbed in warm, soapy water, using a brush to reach into any crevices; (2) the items shall be rinsed in clean water; (3) the items shall be submerged in a sanitizing solution for at least two minutes or in accordance with the instructions on the label of the sanitizing solution; and (4) the items shall be air dried. Through discussion on toy cleaning with staff in infant and toddler rooms staff stated they spray toys twice a week, then changed it to spraying once a day. Follow above procedures. If toy cannot be submerged in sanitizer it can be sprayed but still needs washing and rinsing.

15A NCAC 18A .2825 (a) In child care centers, the walls and ceilings, including doors and windows, of all rooms and areas, shall be kept clean, free of visible fungal growth, and in good repair. All walls and ceilings shall be free of peeling, flaking, chalking, or otherwise deteriorating paint. Repeat- Observed touch up paint needed throughout. Replace ceiling tiles where damaged/stained. No points due to improvement.

15A NCAC 18A .2826 (a). Shielded or shatterproof bulbs shall be used in food preparation, storage, and serving areas and in all rooms used by children. Observed lights not shielded or shatterproof in 4’s and end cap missing off bulb shield in girl’s gang bathroom.

15A NCAC 18A .2831 (b). (b) Pests shall be excluded from the child care center. Traps set for pests shall only be placed in areas that are inaccessible to children. Observed rodent droppings and dead roach in classroom, after school 2. Observed rodent droppings and live roach in hall closet. (These were the 2 areas with excessive storage).

15A NCAC 18A .2807 (a) In child care centers, the preparation of food shall take place only in the kitchen or space equipped as required in Rule .2810. Observed fresh strawberries in refrigerator. To wash fresh fruits and vegetables in the 3-comp sink or prep sink an indirect drain is required.

15A NCAC 18A .2809 (3) Other surfaces that do not come into contact with food shall be made of nonabsorbent material and shall be kept clean and in good repair. Observed 3-comp sink needs replacing. Seams and corners not cleanable.

15A NCAC 18A .2818 (a). Lavatories shall be kept clean and in good repair. Observed soiled vanity tops. Newish looking counter top in infants area needs side pieces to cover exposed particleboard.

15A NCAC 18A .2818 (d). Liquid soap and disposable towels or other hand-drying devices shall be provided at every handwash lavatory area. Observed no paper towels available at 1 classroom handsink.

15A NCAC 18A .2818 (a). In child care centers lavatories shall not be used for storage. Observed many dirty spoons in hand sink, infants. Recommend a container for dirty items that need to go back to the kitchen.

15A NCAC 18A .2822 (a) Toys, equipment, furniture, and any other items accessible to the children shall be kept clean and in good repair. Repeat-Observed toys, containers, shelving units, book cases, and cubby bins with debris. Observed torn books, broken toys and damaged vinyl furniture.

15A NCAC 18A .2825 (a) In child care centers, the walls and ceilings, including doors and windows, of all rooms and areas, shall be kept clean, free of visible fungal growth, and in good repair. All walls and ceilings shall be free of peeling, flaking, chalking, or otherwise deteriorating paint. Repeat- Observed touch up paint needed throughout. Replace ceiling tiles where damaged/stained. Clean walls, doors, door frames with grime build-up, repaint if necessary.

15A NCAC 18A .2830 (c) Dumpsters and other containerized systems shall be kept clean and covered. Observed dumpster rusted through. Discarded toys and chair behind dumpster corral need to be removed

15A NCAC 18A .2832 (a). Child care center premises, including the outdoor learning environment, shall be kept clean, drained to minimize standing water, free of litter and hazards, and maintained in a manner which does not create conditions that attract or harbor pests. Observed 3 containers of standing water on playgrounds. Water too murky to see mosquito larvae, but adult mosquitoes were hovering near containers.

15A NCAC 18A.2803 (e). Handwashing procedures shall include: (1) using liquid soap and tempered water; (2) rubbing hands vigorously with soap and tempered water for 15 seconds; (3) washing all surfaces of the hands, to include the backs of hands, palms, wrists, under fingernails and between fingers; (4) rinsing the hands under tempered water for 10 seconds; (5) drying hands with a paper towel or other hand-drying device; and (6) turning off faucet with a paper towel or other method without recontaminating hands. Observed improper handwashing procedure by staff turning off water with their hand

15A NCAC 18A .2810 (a) (1) (2) When multi-service articles other than when highchair feeding trays are used onsite, each child care center shall have a either: (1) a dishwasher and two-compartment sink, or (2) a three-compartment sink of sufficient size and depth to submerge, wash, rinse and sanitize utensils. Observed 3-comp sink needs replacing. Repair of seams inadequate.

15A NCAC 18A .2815 (e) Hot water supplied to clothes washing machines shall be 120°F or above. Observed washing machine did not meet min of 120F 15A NCAC 18A .2815 (e) Hot water shall be maintained between 80°F and 110°F at handwashing sinks accessible to children. Observed hot water not working at one classroom hand sink.

15A NCAC 18A .2818 (c) Lavatories shall be cleaned and disinfected with each change of use, when visibly soiled, and at least daily. Change of use occurs when a handwash lavatory is used outside of its original intent. Observed staff wash hands in food prep sink after diaper change with no change of use.

15A NCAC 18A .2819 (d) Use approved diapering methods as follows: 1) gather supplies, 2) wear disposable gloves (if needed), 3) use a disposable moist towelette to clean child, wiping front to back, 4) dispose of gloves if used and soiled towelettes, 5) wiping the employee's hands and the child's hands with a separate disposable towelette, 6) slide clean diaper under child and apply diapering products if needed using approved methods, 7) fasten diaper and place clothing on child, 8) wash child's hands, 9) and 10) clean and disinfect diapering surface using approved methods, 11) employee washes their hands. Observed staff needing continual coaching to change diapers properly.

15A NCAC 18A .2822 (a) Toys, equipment, furniture, and any other items accessible to the children shall be kept clean and in good repair. Observed toys, containers and cubby bins with debris.

15A NCAC 18A .2822 (a). In rooms designated for children who are not toilet trained, toys and other mouth-contact surfaces that are used by children shall be cleaned and then sanitized after each use and when visibly dirty. Toys and other mouth-contact surfaces shall be cleaned and sanitized as follows: (1) the items shall be scrubbed in warm, soapy water, using a brush to reach into any crevices; (2) the items shall be rinsed in clean water; (3) the items shall be submerged in a sanitizing solution for at least two minutes or in accordance with the instructions on the label of the sanitizing solution; and (4) the items shall be air dried. Through discussion staff said they spray toys with sanitizer. Follow preceding procedures.

15A NCAC 18A .2825 (a) In child care centers, the walls and ceilings, including doors and windows, of all rooms and areas, shall be kept clean, free of visible fungal growth, and in good repair. All walls and ceilings shall be free of peeling, flaking, chalking, or otherwise deteriorating paint. Observed touch up paint needed throughout. Replace ceiling tiles where damaged/stained.