The Nest School

Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. In space #9, the medication authorization form was not on file and available for review for one jar of A&D Prevent and Heal ointment.

Violation corrected during visit

Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space #6b, two (2) infants did not wash their hands upon arrival. In space #6a, one (1) infant did not wash his hands upon arrival. In space #7a, one (1) child did not wash his hands upon arrival. In space #4, one (1) child did not wash her hands upon arrival.

Violation confirmed corrected by letter received from provider on 8/13/2025

A violation was found for which there is no item number. On July 28, 2025, Environmental Health confirmed that squirrels are present in the attic. Per Sanitation Rule 15A NCAC 18A .2831 (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.

Violation confirmed corrected by letter received from provider on 8/13/2025

Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. In space #1, the medication authorization form was not on file and available for review for one (1) jar of Destin, one (1) bottle of Boogie Diaper Rash spray, and one (1) tube of Aquaphor.

Violation corrected during visit

Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization.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 medication authorization for one tube of Desitin Diaper Cream, stored in the locked cabinet above the sink in space #2, was valid from April 1, 2023, until April 1, 2024. The Desitin Diaper Cream was not returned to the parent or discarded at the end of treatment. The medication authorization for one tube of Vaseline Healing Jelly All Over Body Balm, stored in the locked cabinet above the sink in space #2, was valid from April 18, 2023, until April 18, 2024. The Vaseline Healing Jelly All Over Body Balm was not returned to the parent or discarded at the end of treatment.

Violation confirmed corrected by letter received from provider on 6/12/2024

A current activity plan was not posted for each group of children for reference. In space #4 and space #10, the posted activity plan was dated April 29, 2024 to May 3, 2024.

Violation confirmed corrected by follow-up visit made by consultant on 5/28/2024

An individual written feeding plan was not provided by child's parent or health care provider or was not followed and posted. (omit posting for centers located in a residence) In space #1, the written feeding plan was not posted for two toddlers, twelve months of age. In space #6a, the written feeding plan for one infant, ten months of age was not signed by the parent and dated when the facility received the written feeding plan. In space #6b, the written feeding plan that was posted for one infant, four months of age, did not include page #2 that documented the parent signature, date received by the facility and information regarding the type and amount of food/formula/human milk to serve the infant.

Violation confirmed corrected by follow-up visit made by consultant on 5/28/2024

Fire drills were not practiced monthly and/or the drill record was incomplete. The fire drill conducted on February 20, 2024, at 5:45pm did not document the time required to evacuate. The fire drill conducted on March 11, 2024, at 10:45am did not document the time required to evacuate.

Violation confirmed corrected by follow-up visit made by consultant on 5/28/2024

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, one basket was stored fifty-six inches from the floor surface in the unlocked cabinet above the sink used for handwashing and contained children's over-the-counter topical ointments. In space #2, one box of Care Science Antibacterial Flexible Fabric Adhesive Bandages was stored fifty-six inches from the floor surface, in the unlocked cabinet above the handwashing sink. In space #5, two 18 ounce bottles of Vivante Expert/Care Conditioner with multiple warnings on the label, and one 1.7 ounce bottle of Betta Fix API that noted Danger: Harmful if swallowed, causes eye irritation, causes skin irritation, If swallowed: call a Poison Center or Physician was stored on the top shelf in the unlocked cabinet above the sink used for handwashing.

Violation confirmed corrected by follow-up visit made by consultant on 5/28/2024

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 #2, the medication authorization for one 4 ounce tube of Desitin Diaper Cream that was monitored was valid from April 1, 2023, to April 1, 2024. The medication authorization for one, 1.4 ounce tube of Vaseline Healing Jelly All-Over Body Balm that was monitored was valid from April 18, 2023 to April 18, 2024. . The medication authorization for one, 3.5 ounce tube of Auquaphor Baby 3 in 1 Diaper Rash Cream that was monitored and had an expiration date of November 2023, was valid from June 14, 2022 to December 14, 2022.

Violation confirmed corrected by letter received from provider on 6/12/2024

The indoor and/or outdoor premises was not checked once a day, prior to initial use, ensuring debris, and broken equipment was removed and disposed of. Upon arrival, children were observed on playground #4. One plastic cup, one white tissue, one plastic wrapper and one paper plate were observed on playground #4.

Violation confirmed corrected by follow-up visit made by consultant on 5/28/2024

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 #1, one (1) sixty-four ounce bottle of Bubble Solution with Funnel Bubble Play that listed a warning regarding small parts and not suitable for children under three years of age and one Ziploc plastic bag was stored in the unlocked cabinet below the sink used for handwashing. In space #6b, two plastic packages of Cuties Sensitive Unscented Baby Wipes and one plastic package of Pampers Sensitive Baby Wipes stored fifty-six inches from the floor surface in the unlocked middle cabinet above the handwashing sink. The warning on the plastic packages listed to avoid danger of suffocation, keep outer wrapper and plastic bags away from babies and children. In space #7b, one plastic package of Cuties Sensitive Unscented Baby Wipes was stored fifty-six inches from the floor surface in the unlocked cabinet above the sink used for handwashing. In space #8, one box of Gallon sized Ziploc Storage bags were stored fifty-six inches from the floor surface in the unlocked cabinet above the sink used for handwashing.

Violation confirmed corrected by follow-up visit made by consultant on 5/28/2024

Infants under the age of 12 months were not placed on their backs for sleeping unless the center had obtained the appropriate written waiver. In space 6a, the Infant Sleep Chart documented that one infant, ten months of age was initially placed on the tummy to sleep at 12:45pm on April 30, 2024, and at 12:15pm on May 7, 2024. In space #6a, the Infant Sleep Chart documented that one infant, nine months of age was initially placed on their tummy to sleep at 12:15pm on May 7, 2024. In space #6a, the Infant Sleep Chart documented that one infant, ten months of age was initially placed on their side to sleep at 12pm on May 3, 2024, on their tummy to sleep at 12:35pm on May 6, 2024, and on their side to sleep at 1:30pm on May 7, 2024, and on their tummy to sleep at 12:15pm on May 8, 2024. In space 6a, the Infant Sleep Chart documented that one infant, ten months of age was initially placed on their tummy to sleep at 12:07pm on May 6, 2024, at 12:45pm on May 7, 2024, and at 12:30pm on May 8, 2024. In space #6a, the Infant Sleep Chart documented that one infant, eleven months of age was initially placed on their side to sleep at 1:30pm on May 7, 2024.

Violation confirmed corrected by follow-up visit made by consultant on 5/28/2024

Staff required to receive on-going training had not completed the required number of hours according to their education and experience. One lead teacher with a hire date of September 22, 2022, received two of the required ten hours of ongoing training.

Violation confirmed corrected by follow-up visit made by consultant on 5/28/2024

Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. One lead teacher with a hire date of April 4, 2023, did not have an annual staff evaluation on file for review. One lead teacher with a hire date of September 27, 2022, had a staff development plan on file dated October 7, 2022. One lead teacher with a hire date of August 18, 2022, had a staff development plan on file dated August 16, 2022. One lead teacher with a hire date of August 18, 2022, had a staff development plan on file dated August 16, 2022.

Violation confirmed corrected by follow-up visit made by consultant on 5/28/2024

Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The most recent emergency drill, shelter-in-place, documented on the drill record was conducted on December 20, 2023.

Violation confirmed corrected by follow-up visit made by consultant on 5/28/2024

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. The EPR Plan was not available for review.

Violation confirmed corrected by letter received from provider on 6/6/2024

Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. In space #1, the medication authorization was not dated when the parent signed the form giving authorization to administer Boudreaux's Butt Paste. In space #8, the medication authorization for one, 1.75 ounce container of Vaseline did not document the dates the authorization was valid.

Violation confirmed corrected by follow-up visit made by consultant on 5/28/2024

The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One employee with a hire date of January 8, 2024, completed the Recognizing and Responding to Suspicions of Child Maltreatment training on April 15, 2024. One employee with a hire date of November 7, 2023, completed the Recognizing and Responding to Suspicions of Child Maltreatment training on April 15, 2024.

Violation confirmed corrected by follow-up visit made by consultant on 5/28/2024

Staff did not complete the health and safety training within one year of employment. One lead teacher with a hire date of April 4, 2023, did not complete the required health and safety training.

Violation confirmed corrected by follow-up visit made by consultant on 5/28/2024

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 aerosol can of Colorations Foam Paint was stored in the unlocked cabinet above the sink in space #4. One (1) twenty-four (24) ounce bottle of Clorox Toilet Bowl Cleaner and one (1) thirty-two (32) ounce bottle of Great Value Cleaner with Bleach were stored on top of the cubbies used to store children's personal belongings, in space #10.

Violation corrected during visit

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 #4, one aerosol can of Glade Oak Air Freshener and two aerosol cans of Mika's Fun House Foam Soap (Groovy Grape, Raspberry-Lime), were stored above the sink in the unlocked white cabinet. In space #5, one aerosol can of Lysol Disinfecting Spray, two aerosol cans of Barbasol Original Shaving Cream, and one aerosol can of Mika's Fun House Foam Soap (Very Berry) were stored in the unlocked white cabinet above the sink. In space #8, two aerosol cans of Mika's Fun House Foam Soap (Raspberry-Lime, Groovy Grape) were stored in the unlocked upper white cabinet to the right of the sink.

Violation corrected during visit