EVERBROOK ACADEMY

15A NCAC 18A .2804 (k) Lunches, snacks, and other meals that a child brings from home to the child care center shall be labeled with the date on which the food is brought to the child care center and the name of the child to whom the food belongs at the child's home and shall be returned to the child's home or discarded at the end of each day. Observed a container of baby food from home in infant room refrigerator missing the date label. Needs date label. 15A NCAC 18A .2806 (a) Once pre-packaged food has been opened, the food shall be stored in clean, resealable bags or containers made of plastic or glass that are tightly covered and manufactured for the purpose of food storage. Observed snacks in nonresealable bags in Preschool and Early Preschool classrooms. Needs to be in resealable bags/containers. 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 specialty bulk milk in kitchen refrigerator missing the name and date received. Needs to be labeled with name and date received. 15A NCAC 18A .2810(f) Water from a handwash lavatory shall not be used for bottle warming or to prepare formula, mix dry cereals, or other foods. Observed facility using warm water from handwashing food prep sink in classroom for bottle warming in the infant room. Water from a handwash lavatory shall not be used for bottle warming.

General Comment: 15A NCAC 18A .2812 (e) Multi-service articles, including highchair feeding trays, shall be washed, rinsed and sanitized in the child care center kitchen after each use. Observed kitchen staff washing dishes at 3-comp sink using middle compartment for washing and rinsing with hose and stated he sanitizes after. No sanitzer was in the third compartment. EHS went over proper wash, rinse, sanitize procedure. The facility has a dish machine which they stated is not being used.

15A NCAC 18A .2812 (j) (j) A sanitizing solution shall be provided for cleaning purposes. Observed sanitizer at 500 ppm chlorine. Needs to be 50-200 ppm.

15A NCAC 18A .2817 (a). Storage in toilet rooms shall be limited to toileting and diapering supplies. Observed storage in bathroom of Toddler 1 and Toddler 2. REPEAT. 15A NCAC 18A .2818 (a). In child care centers lavatories shall not be used for storage. Observed container holding bottles for bottle warming in infant room stored in food prep sink. Lavatories shall not be used for storage.

15A NCAC 18A .2812 (i) An approved disinfectant shall be provided for cleaning purposes. When a chlorine solution is prepared by a child care center employee for use as an approved disinfectant, then the solution shall be prepared for use within 24 hours, and a testing method shall be used to ensure compliance with the prescribed chlorine concentration (500 -800 ppm). Observed no disinfectant at the diaper changing station in Toddler 1 classroom. EHS asked staff how they had been disinfecting after diaper changes and they stated they did have disinfectant prior to nap time. Facility needs to have disinfectant at diaper changing stations for proper cleaning.

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 employee change a diaper in Infant classroom skip step 5. Staff member started to take the child back to play area without washing hands but was addressed and told to wash the child’s hands as they could hold their head up. EHS and the director discussed diaper changing procedures and the director stated they planned to be doing a review of diaper training soon.

15A NCAC 18A .2820 (c ) Sanitizing, disinfecting, and detergent solutions shall be labeled with the product name (ex. "Sanitizer"). Observed two spray bottles labeled “water” were actually disinfectant. Needs correct labels.

General Comment: 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 children sleeping on cots less than 18 inches apart in Early Preschool classrooms. Needs to be 18 inches apart or separated by partitions.

General Comment: 15A NCAC 18A .2822 (d).Water play centers shall be filled with potable water immediately before children begin a water play session. Water shall be emptied after each play session and at a minimum each morning and afternoon, or more often if no longer clean. Observed water play table in Toddler 2 filled and stored in bathroom. The teacher stated she fills the water table in the morning and uses it in the afternoon. Needs to be filled immediately before use.

General Comment: 15A NCAC 18A .2822 (b) and .2810 (f).Hard plastic toys may be washed, rinsed, and sanitized in a dishwasher, food preparation handwashing sink, or in the kitchen sink. Observed teacher rinse pacifier in diaper changing sink. Needs to follow change of use procedures and clean toys in food prep sink.

General Comment: 15A NCAC 18A .2803 (a) and (c), .2836 (15).Child care center employees and children shall wash their hands when required. Observed two children’s hands not washed upon arrival in infant 2 room. Children shall wash hands upon arrival.

15A NCAC 18A .2804 (k) Lunches, snacks, and other meals that a child brings from home to the child care center shall be labeled with the date on which the food is brought to the child care center and the name of the child to whom the food belongs at the child's home and shall be returned to the child's home or discarded at the end of each day. Observed milk bottle and pouch snack in Toddler 1 refrigerator with no date label. Needs date label. 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 milk and yogurts stored in small refrigerator in Toddler 1 classroom. Needs to be in full size refrigerator.

General Comment: 15A NCAC 18A .2814 (a) In child care centers, food-contact surfaces, equipment, utensils, and single service articles shall be protected from contamination. Observed boxes of single service plates and cups stored on the floor in the kitchen. Needs to be stored off the floor.

15A NCAC 18A .2817 (a). Storage in toilet rooms shall be limited to toileting and diapering supplies. Observed large toys stored in Toddler 2 bathroom.

General Comment: 15A NCAC 18A .2820 (b). All hazardous items must be stored behind lock and key. Observed cabinet containing aerosols in Toddler 2 classroom was unlocked. Lock on cabinet was not working on one door. 15A NCAC 18A .2820 (b). Purses that contain hazardous items shall be stored behind lock and key. Observed teacher purse containing hazardous items stored in unlocked cabinet in EPS. Needs to be stored locked. CDI - cabinet was locked.

15A NCAC 18A .2820 (d) Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use but are not required to be in locked storage. A product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. Observed locks broken to drawer containing sunscreen/diaper creams in EPS and Toddler 1. Needs repair. Items can be stored 5ft up or locked in a different cabinet.

General Comment: 15A NCAC 18A .2804 (h) After the completion of each feeding, any leftover formula, human milk, or other bottled beverages used during the feeding shall be discarded or sent home with the child whose name is on the label for the formula, human milk, or bottled beverage at the end of each day. Feeding is complete when the child care center employee has stopped feeding the child and the child has been removed from the feeding area in the child care center and returned to other activities. Bottles previously used for feeding shall not be returned to communal mechanical refrigeration. Observed bottle on counter in infant 1 partially consumed. Facility stated the child takes breaks from feeding and the child was placed in play area with other children. Bottles cannot be returned to child once feeding has been completed. Feeding is completed when child has stopped feeding and returned to other activities. EHS advised to keep children from continuing other activities until feeding is complete. Facility had stated they were following the “1 hour rule” and EHS informed facility the “1 hour rule” is not part of NC childcare sanitation rules. 15A NCAC 18A .2810 (f) Water from a handwash lavatory shall not be used for bottle warming or to prepare formula, mix dry cereals, or other foods. Observed facility using water from handwash lavatory in infant 2 to fill bin used for bottle warming. Water from a handwash lavatory shall not be used for bottle warming.

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 at Toddler 2 handsink at 115F. Observed handsink in prek bathroom jump up to 117F before falling back to 110F. Needs to be 80-110F.

General Comment: 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 two children less than 18 inches apart in Toddler 2. CDI - Children were moved 18 inches apart.

15A NCAC 18A .2806 (a) Once pre-packaged food has been opened, the food shall be stored in clean, resealable bags or containers made of plastic or glass that are tightly covered and manufactured for the purpose of food storage. Observed opened package of cereal and pasta sealed with tape in kitchen pantry. EHS educated center on notated rule. -General comment.

15A NCAC 18A .2817 (a). Storage in toilet rooms shall be limited to toileting and diapering supplies. Observed toys stored in toddler 2 restroom.

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 book stems damaged in toddler 1 classroom. Replace.

15A NCAC 18A .2830 (c) Dumpsters and other containerized systems shall be kept clean and covered. Observed 1 sliding door opened to dumpster. Observed dilapidated structures stored outside of dumpster area. Remove.

15A NCAC 18A .2818 (d). Liquid soap and disposable towels or other hand-drying devices shall be provided at every handwash lavatory area. Observed soap and paper towel dispensers on wall at kitchen prep sink. Dispensers need to be removed

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 improper diaper changing procedure in toddler 2. Steps skipped 4,5. Staff turned off water with their hand after hand wash.

15A NCAC 18A .2820 (b). All hazardous items must be stored behind lock and key. Observed white board cleaner unlocked in Infant 2 class. Lock up all “cleaners” even if they say they are non-toxic

15A NCAC 18A .2820 (f). Coat hooks not in individual cubbies or lockers must be 12 horizontal inches apart. Observed back coat hooks being used for coats. Only 8 inches between front and back hooks.

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 several soft toys with nasal discharge in several classrooms. Evaluate toys daily.

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 lots of cardboard boxes in dumpster corral. Get a recycling dumpster or haul away more frequently.

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. REPEAT-Observed staff members turning off water with hand. Children in preschool class not being coached and touching garbage can lids.

15A NCAC 18A .2804 (d) All human milk, formula, and other bottled beverages, including beverages in sippy cups, that are sent from home shall be fully prepared and labeled with the date received at the child care center and the name of the child to whom the milk, formula, or beverage belongs before being brought to the child care center. Observed bottles not dated in both infant rooms.

15A NCAC 18A .2807 (h) Metal stem-type, thin probe, numerically scaled indicating product thermometers, accurate to ± 3 degrees Fahrenheit shall be used to ensure the maintenance of the internal cooking temperatures of all potentially hazardous foods required under this Rule. Repeat-Observed no digital thermometer. Dial top thermometers were not thin probe

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 coffee dispensers used to fill containers to heat bottles. Repeat-Hot water in dispenser 121F and 125F. The water put into the dispenser should not be >110F. Measure temp with food thermometer. (Provisional item not corrected)

15A NCAC 18A .2817 (a. All toilet fixtures shall be kept clean and in good repair. Observed 2 toilets with pink ring in bowl, need more frequent cleaning.

15A NCAC 18A .2818 (d). Liquid soap and disposable towels or other hand-drying devices shall be provided at every handwash lavatory area. Repeat-Observed several hand sinks missing paper towels or soap

15A NCAC 18A .2818 (a). In child care centers lavatories shall not be used for storage. Repeat- Observed 3 used diapers in diaper changing hand wash sink in Toddler 1. Art brushes in diaper changing hand sink in Early Preschool class. Wash toys/art supplies in food prep hand sink after doing a 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. Repeat-Observed diaper changes with steps missing in both toddler rooms. Observed child had “blow out” clean clothes were in bin across room, child picked up and carried to get new clothes, most likely contaminating staff’s sweater. Steps missed- 1, 4, 5, 15A NCAC 18A .2819 (h) Signs that instruct child care center employees on proper methods of diaper changing and handwashing as set forth in the rules of this Section shall be posted in each diaper changing area. Observed diaper changing signs not located where can be read while doing a diaper change.

15A NCAC 18A .2820 (b). All hazardous items must be stored behind lock and key. Observed laundry room was not latched (was not latched last week), have self closure repaired. Pull door closed to make sure it latches.

15A NCAC 18A .2821 (f). Linens used in rooms where the children in care are less than 12 months old shall be changed and laundered when soiled and otherwise at least daily. Observed soiled sheets on several cribs. Staff said they change the sheets every other day (children < 12 months)

15A NCAC 18A .2822 (d) The water play centers, including toys, shall be cleaned and sanitized at least daily or more often if no longer clean. Water play is prohibited during the outbreak and investigation of a communicable disease or condition at the child care center. Observed water play station with water, staff said they clean every few days and it was filled yesterday.

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 in Infant 2 classroom I asked where the dirty toys were put. Reply was in the dirty toy bin (which was empty) i asked if toys had already been cleaned this morning? Staff said no, toys were all over the floor and being mouthed. Pick up toys that have been mouthed when child has discarded it and put in dirty toy bin.

15A NCAC 18A .2824 (b). Floors and floor coverings in sleeping and play areas shall be kept clean and in good repair. Observed dried puddle of urine on bathroom floor, The Brook

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 several staff members turning off water with hand, touching garbage can lids. One staff member just rinsed hands and tapped off excess water on side of sink. Observed older children not being coached and turning off water with hands.

15A NCAC 18A .2804 (h) After the completion of each feeding, any leftover formula, human milk, or other bottled beverages used during the feeding shall be discarded or sent home with the child whose name is on the label for the formula, human milk, or bottled beverage at the end of each day. Feeding is complete when the child care center employee has stopped feeding the child and the child has been removed from the feeding area in the child care center and returned to other activities. Bottles previously used for feeding shall not be returned to communal mechanical refrigeration. Observed staff putting used bottles back into refrigerator, infant 2. 15A NCAC 18A .2808 (a) In child care centers, milk and milk products used for drinking purposes shall be stored in the original commercially filled container until the milk or milk product is served for drinking. Unused milk and milk products that are transferred from the original commercially filled container into a separate container, such as a pitcher, for serving shall be discarded and shall not be put back into the original commercial filled container or stored in the container that was used for serving. Observed pitcher of milk in cooler, dispose of after meal service 15A NCAC 18A .2806 (a) Once pre-packaged food has been opened, the food shall be stored in clean, resealable bags or containers made of plastic or glass that are tightly covered and manufactured for the purpose of food storage. Observed open bags of crackers not sealed in baggie or lidded container.

15A NCAC 18A .2807 (h) Metal stem-type, thin probe, numerically scaled indicating product thermometers, accurate to ± 3 degrees Fahrenheit shall be used to ensure the maintenance of the internal cooking temperatures of all potentially hazardous foods required under this Rule. Observed no digital thermometer. Dial top thermometers were not thin probe

15A NCAC 18A .2812 (e) Multi-service articles, including highchair feeding trays, shall be washed, rinsed and sanitized in the child care center kitchen after each use. Observed dishes in sanitizing vat < 100ppm quat. Using Steritabs, measure volume of 3rd compartment and convert to gallons to measure how many tabs are required. Through discussion staff said high chair trays are being cleaned in the classroom. 15A NCAC 18A .2812(c) When utensils and equipment are washed mechanically using a dishwasher, food-contact surfaces of equipment and utensils shall be sanitized according to the dishwasher manufacturer's instructions. When commercial dishwashing equipment is used, the dishwasher shall be equipped with a temperature indicating device that is accurate to two degrees Fahrenheit. Observed Dishmachine (high temp) with no chemicals set up to dispense.

15A NCAC 18A .2812 (g) A testing method or equipment shall be used in accordance with the product manufacturer's instructions to test the strengths of sanitizing solutions to ensure the prescribed concentrations are met. Observed sanitizer > 1000 ppm chlorine in infant 1. Several classrooms did not have a sanitizer bottle.

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 coffee dispensers used to fill containers to heat bottles. Hot water in dispenser 155F. The water put into the dispenser should not be >110F. Measure temp with food thermometer.

15A NCAC 18A .2817 (a. All toilet fixtures shall be kept clean and in good repair. Observed urine on toilet seats in 2 classrooms. Monitor bathroom’s cleanliness more frequently.

15A NCAC 18A .2818 (d). Liquid soap and disposable towels or other hand-drying devices shall be provided at every handwash lavatory area. Observed several paper towel dispensers without paper towels

15A NCAC 18A .2818 (a). In child care centers lavatories shall not be used for storage. Observed dirty toys, spoons stored in hand sinks. Put dirty toys in dirty toy bin until cleaned, same with dirty dishes/silverware.

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 several diaper changes done incorrectly, with several steps missing. One staff member kept dirty gloves on until she washed her hands at the end. Several classrooms didn’t have disinfectant available. Staff retraining is needed

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 Benadryl unlocked, toddler 1.

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, hand sanitizer and diaper creams stored < 5 feet above floor, several classrooms.

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 teacher purse stored unlocked and < 5 feet above floor.

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 cots not assigned in Pre-k class.