SANITATION OF CHILD CARE CENTERS 15A NCAC 18A .2801

SUBCHAPTER 18A - SANITATION

SECTION .2800 - SANITATION OF CHILD CARE CENTERS

15A NCAC 18A .2801 DEFINITIONS

The following definitions shall apply throughout this Section:

(1) "Adequate" means to be of the size, volume, or technical specifications necessary to effectively

accommodate and support the planned, current, or projected workloads for the technology or

constructed space.

(2) "Approved Disinfectant" means a chlorine solution containing 500 to 800 parts per million (ppm)

of chlorine or a disinfectant as defined at 40 C.F.R. 158.2203 that is registered with the United States

Environmental Protection Agency (EPA) in accordance with 40 C.F.R. 152 with use indicated in

schools and child care settings and that is prepared and maintained in accordance with Rule .2812(i)

of this Section.

(3) "Chain or Franchise Child Care Center" means a child care center that operates under the same

business name and prototype design concept, with common ownership or management, as nine or

more other child care centers pursuant to a franchise agreement under the same franchisor as nine

or more other child care centers.

(4) "Child Care Administrator" means as defined at G.S. 110-86(2a).

(5) "Child Care Center" means as defined at 10A NCAC 09 .0102(6).

(6) "Child Care Operator" or "Operator" means as defined at G.S. 110-86(7).

(7) "Clean" means that an object or surface has been made free of garbage, soil, dust, hair, dander, food,

bodily fluids and secretions, and feces.

(8) "Communicable Condition" means as defined at G.S. 130A-2(1b).

(9) "Communicable Disease" means as defined at G.S. 130A-2(1c).

(10) "Department" or "DHHS" means the North Carolina Department of Health and Human Services or

the Department's authorized agent pursuant to G.S. 130A-4.

(11) "Designated Emergency Medication" means a medication needed to immediately treat a life-

threatening medical event that is administered in accordance with 10A NCAC 09 .0803(10) and

G.S. 110-102.1A.

(12) "Detergent Solution" means a solution comprised of water and soap.

(13) "Disinfect" means a non-sporicidal process of using an approved disinfectant on inanimate surfaces

to destroy or irreversibly inactivate fungi, viruses, and bacteria.

(14) "Food" means any raw, cooked, or processed edible substance, ice, beverage, or ingredient used or

intended for use or for sale in whole or in part for human consumption.

(15) "Food-contact surface" means as defined in Part 1-201.10 of the Food Code incorporated by

reference at 15A NCAC 18A .2650 as amended by 15A NCAC 18A .2651.

(16) "Food Preparation" means the handling of foods or utensils in the preparation of meals, including

opening and closing of baby bottles, baby food jars, and cereal boxes, as well as the opening and

closing of any other food items during the assembly of ingredients.

(17) "Food Service" means the distribution of foods for consumption, including milk placed in a pitcher

or other serving container, ice that is transported, stored and dispensed, the distribution of children's

bagged lunches and snacks sent from home, and the use of utensils to prevent direct food contact.

(18) "Frying" means to cook over direct heat in hot oil or fat. This includes the oil or fat that is generated

by the food or added to the cooking utensil.

(19) "Garbage" means as defined at G.S. 130A-290(a)(7).

(20) "Good Repair" means as defined at 15A NCAC 18A .2651(8). Items that are in good repair shall be

free of substrate damage, deterioration, peeling surfaces, and broken or missing parts and shall

operate in accordance with the manufacturer's or builder's instructions.

(21) "Hand Antiseptic" means as defined in Part 2-301.16 of the Food Code incorporated by reference at

15A NCAC 18A .2650 as amended by 15A NCAC 18A .2652.

(22) "Handwash Lavatory" means a sink that is equipped with hot and cold water under pressure and is

used primarily for handwashing.

(23) "Hazard" means as defined in Part 1-201.10 of the Food Code incorporated by reference at 15A

NCAC 18A .2650 as amended by 15A NCAC 18A .2651, except that "consumer" shall be replaced

with "child."

(24) "Hermetically Sealed Container" means as defined in Part 1-201.10 of the Food Code incorporated

by reference at 15A NCAC 18A .2650 as amended by 15A NCAC 18A .2651.

(25) "Licensing Agency" means the DHHS, Division of Child Development and Early Education.

(26) "Local Health Department" means as defined at G.S. 130A-2(5).

(27) "Milk Products" means as defined in Section 1 of the 2017 Grade "A" Pasteurized Milk Ordinance,

including subsequent amendments and editions, established by the U.S. Department of Health and

Human Services, Food and Drug Administration, which is hereby incorporated by reference and

available free of charge at https://www.fda.gov/media/114169/download.

(28) "Multi-Service Articles" means tableware, including flatware and hollowware that are designed,

fabricated, and intended by the manufacturer to be washed, rinsed, sanitized, and re-used.

(29) "Multi-Use Articles" means bulk food containers and utensils designed, fabricated, and intended by

the manufacturer to be washed, rinsed, sanitized, and re-used. The term includes food storage

containers, beverage pitchers, serving spoons and bowls, tongs, and spatulas. The term does not

include multi-service articles as defined in this Rule.

(30) "Outdoor Learning Environment" means as set forth at 10A NCAC 09 .0605.

(31) "Pest" means as defined at G.S. 143-460(26a).

(32) "Potable Water" means water from a potable water supply as defined at 15A NCAC 18C

.0102(c)(18).

(33) "Potentially Hazardous Food" means any food or ingredient, natural or synthetic, in a form capable

of supporting the growth of infectious or toxigenic microorganisms, including Clostridium

botulinum. This term includes raw or heat-treated food of animal origin, raw seed sprouts, and heat-

treated foods of plant origin. The term does not include foods which have a pH level of 4.6 or below

or a water activity value of 0.85 or less.

(34) "Sanitize" means a process of using a sanitizing solution on inanimate surfaces to destroy or

irreversibly inactivate bacteria.

(35) "Sanitizing Solution" means a solution containing 50 to 200 parts per million (ppm) of chlorine or

a sanitizer as defined at 40 C.F.R. 158.2203 that is registered with the EPA in accordance with 40

C.F.R. 152 that is approved by the EPA for use on food-contact surfaces, does not require a final

rinse step, and has a testing method that can be used by child care center employees to confirm that

the prescribed chemical concentrations are met and that is prepared and maintained in accordance

with Rule .2812(j) of this Section.

(36) "School Age" means a school-aged child as defined at 10A NCAC 09 .0102(42).

(37) "Single-Service Articles" means tableware, including flatware and hollowware, carry-out utensils

and other items such as bags, containers, stirrers, straws, toothpicks, and wrappers that are designed,

fabricated and intended by the manufacturer for one-time use.

(38) "Single-Use Articles" means bulk food containers and utensils intended by the manufacturer to be

used once and discarded. The term includes formed buckets, bread wrappers, pickle barrels, and No.

10 cans. The term does not include single-service articles as defined in this Rule.

(39) "Tempered Water" means water that is between 80 and 110 degrees Fahrenheit.

(40) "Utensil" means any kitchenware, tableware, glassware, cutlery, containers or other equipment that

food or drink comes in contact with during storage, preparation or serving.

(41) "Water Play Center" means water tables or containers that allow children to scoop, splash, pour, and

play with water to explore their senses.

(42) "Work Surfaces" means surfaces used for food service, stove tops, food contact utensil and

dishwashing sinks, surfaces used for air drying, drain boards, surfaces used for diaper changing,

counter top surfaces, and children's work tables, desks, and easels.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. March 1, 1995;

Temporary Amendment Eff. April 15, 1998;

Amended Eff. July 1, 2006; January 1, 2006; April 1, 1999;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2802 APPROVAL OF CONSTRUCTION AND RENOVATION PLANS

(a) Construction plans drawn to scale and specifications for a new child care center that is not a chain or franchise

child care center shall be submitted by the operator or the operator's designee to the local health department that serves

the county in which the child care center is located for review and approval prior to initiating construction. Plans

drawn to scale and specifications for changes to building dimensions, kitchen specifications, or other modifications to

existing child care centers, including chain or franchise child care centers, shall also be submitted to the local health

department for review and approval prior to initiating construction. Construction plans drawn to scale and

specifications for prototype chain or franchise child care centers shall be submitted to DHHS, Division of Public

Health, Environmental Health Section by mail at 5605 Six Forks Road, 1632 Mail Service Center, Raleigh, North

Carolina 27699-1632. When requested by an operator of a child care center or by the Secretary of the Department, the

local health department shall visit or inspect an existing or proposed center, within 30 days of the request, to determine

compliance with this Section.

(b) The local health department or the DHHS, Division of Public Health, Environmental Health Section, as applicable,

shall approve plans described in Paragraph (a) of this Rule when the plans meet the requirements of the rules of this

Section that pertain to the construction or renovation of child care centers.

History Note: Authority G.S. 110-91; 110-92;

Eff. July 1, 1991;

Temporary Amendment Eff. April 15, 1998;

Amended Eff. April 1, 1999;

Temporary Amendment Eff. December 1, 1999;

Amended Eff. January 1, 2006; April 1, 2001;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2803 HANDWASHING

(a) Child care center employees shall wash their hands as follows when at work in a child care center:

(1) upon reporting for work at the child care center:

(2) before and after handling or preparing food;

(3) before bottle feeding a child;

(4) before providing food service;

(5) before handling clean utensils;

(6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions,

vomitus, feces, urine, blood, secretions from sores, and pustulant discharge;

(7) after diaper changing;

(8) after handling soiled items that are not clean;

(9) after being outdoors;

(10) after handling animals or animal cages; and

(11) after removing disposable gloves.

(b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule

except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in

lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule

when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's

action that necessitates handwashing is diapering, food preparation, or food service.

(1) upon arrival at the child care center;

(2) after each diaper change or visit to the toilet;

(3) before eating meals or snacks;

(4) before and after water play;

(5) after being outdoors; and

(6) after handling animals or animal cages.

(d) Except when the action that necessitates handwashing is diapering and before eating meals or snacks, hand

antiseptics may be used in lieu of handwashing while a child is outdoors, provided that the child's hands are washed

when the child returns indoors.

(e) Handwashing procedures shall include the following steps:

(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 the 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.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. February 1, 1995;

Temporary Amendment Eff. April 15, 1998;

Amended Eff. July 1, 2006; January 1, 2006; April 1, 1999;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2804 FOOD SUPPLIES

(a) In child care centers, food shall be kept free from spoilage, filth, or other contamination and shall be safe for

human consumption. Potentially hazardous foods, including foods packaged in hermetically sealed containers, shall

be obtained only from sources that are permitted or inspected by a local health department, the North Carolina

Department of Agriculture and Consumer Services, or other government agency. The use of food packaged in

hermetically sealed containers that was not prepared in a commercial food processing establishment is prohibited.

Food prepared at home and sent to a child care center to be shared with other children shall be limited to baked goods

that are not potentially hazardous foods.

(b) Milk products that are used shall be Grade "A" milk and milk products, as set forth in Section 1 of the 2017 Grade

"A" Pasteurized Milk Ordinance, including subsequent amendments and editions, established by the U.S. Department

of Health and Human Services, Food and Drug Administration, which is hereby incorporated by reference and

available free of charge at https://www.fda.gov/media/114169/download, in fluid form or evaporated milk. Unless

prescribed by a health care provider, dry milk and dry milk products shall be used only for cooking purposes, including

cooked pudding desserts and flavored hot beverages.

batter, brownie mix, milkshakes, and ice cream shall not be consumed by children. This requirement shall not apply

when a pasteurized egg product is used as a substitute for raw eggs.

(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. All human milk, formula, and

other bottled beverages shall be sent home with the child whose name is on the label or discarded at the end of each

day. Formula and other beverages that require refrigeration, baby food that has been opened, and human milk shall be

labeled with the name of the child to whom the beverage, baby food, or milk belongs and shall be refrigerated at 45

degrees Fahrenheit or below.

(e) Frozen human milk may be stored frozen for three months. Any frozen human milk stored beyond seven days

shall be stored in the freezer compartment of a full-size refrigerator that has a separate door to the freezer, in a chest

freezer, or in an upright deep freezer. Frozen human milk shall be thawed in accordance with of Rule .2807(i)(1) or

(i)(2) of this Section and prepared in the child care center's kitchen or food preparation area. In addition to the labeling

required by Paragraph (d) of this Rule, frozen human milk shall be labeled with the date that it is thawed for use.

Human milk that was previously frozen and has been thawed shall be refrigerated and stored for no more than 24

hours from when it was thawed. Human milk that was previously frozen and has been thawed shall not be refrozen

for storage at the child care center.

(f) Formula provided by the child care center shall be commercial ready-to-feed formula that is pre-packaged in

single-use containers. Formula that does not meet these requirements and human milk may be provided to a child by

child care center employees as prescribed by the child's health care provider or as instructed, in writing, by the child's

parent or guardian. Bottles and other drinking utensils provided by the child care center shall be sanitized in accordance

with this Section.

(g) After opening, jars of baby food shall be covered, labeled with the date on which they were opened, refrigerated

and used within two days of opening, provided that the baby food is not served directly from the jar. 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.

(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. Nothing in these

Rules shall prohibit human milk from being sent home at the end of the day with the child whose name is on the label

for the human milk instead of being discarded when the child's parent or guardian has given the child care center

written permission to send the human milk home.

(i) A water bottle that a child brings to the child care center from home and that is used only for water consumption

by that child shall be exempt from the requirements of Paragraph (h) of this Rule. Instead, the water bottle shall be

labeled with the name of the child to whom the water bottle belongs, individually stored in the child's cubby, and sent

home with the child at the end of the day.

(j) Child care centers that receive and provide children with prepared meals or snacks from sources outside the child

care centers, other than meals or snacks sent from home, shall use meals and snacks obtained from food establishments

that are permitted by a local health department, organizations that only serve prepared meals to child care centers, or

another child care center inspected by a local health department. Child care centers may also receive and provide

children with prepared meals from organizations not licensed as child care centers only when these organizations are

providing prepared meals to licensed child care centers and are inspected in the county where the meal is prepared in

accordance with G.S. 110-91(1). The inspection of these organizations shall be made by the local health department

at the same time the inspection of the licensed child care center receiving these prepared meals is done. The inspection

report of the organization providing these meals shall be a part of the inspection of the licensed child care center

receiving the prepared meals, unless the organization is a permitted food handling establishment. Food shall be

transported to the child care center that is receiving the prepared meals in a manner that meets the requirements of the

Rules of this Section relating to hazards, food protection, and storage.

(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. Lunches, snacks, and other

meals containing potentially hazardous foods shall be refrigerated at 45 degrees Fahrenheit or below and stored in the

child care center kitchen or approved food preparation area. Hot foods that a child brings from home to the child care

center in double-walled, insulated thermos containers may be stored outside of refrigeration at the child care center

with the written permission of the child's parent or guardian.

(l) Nothing in the Rules of this Section shall prohibit the use of fresh fruits and vegetables, including those grown at

the child care center, so long as the fruits and vegetables meet the requirements of the rules of this Section and are

washed before being served.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. February 1, 1995; January 1, 1992;

Temporary Amendment Eff. April 15, 1998;

Amended Eff. July 1, 2006; January 1, 2006; April 1, 1999;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION

(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.

(b) Food that is stored in child care center classrooms or other rooms intended for child care use, shall be limited to

foods that are individually packaged unless the classroom is equipped with a food preparation area.

child care centers that are not equipped with a food preparation area when all food preparation involving the bulk dry

goods or frozen food is done in the kitchen or an approved food preparation area.

(d) Bulk food stored in a refrigerator shall be stored at 45 degrees Fahrenheit or below and stored in the child care

center's kitchen or in an approved food preparation area equipped with a full-size refrigerator. 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 this Paragraph

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.

(e) Dry goods that are stored in containers shall be labeled.

(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 Paragraph (g) of this Rule.

(g) Food shall be stored above the floor and in a manner to protect it from dust, pests, drip, splash, and other

contamination.

(h) Raw meats, poultry, fish, shellfish and eggs shall be stored in a refrigerator or freezer on shelving beneath and

separate from other foods. 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.

(i) Sealed, commercially pre-packaged food may be stored in undrained ice as long as the food is not fully submerged

in ice or water. Wrapped sandwiches and other foods shall not be stored in direct contact with ice.

(j) The following shall apply to refrigerated storage of food:

(1) Refrigeration equipment shall be provided in such number and of such capacity to ensure the

maintenance of potentially hazardous food at the required temperatures during storage. Each

refrigerator shall be provided with a numerically scaled indicating thermometer that is accurate to ±

3 degrees Fahrenheit and located to measure the air temperature in the warmest part of the

refrigerator. Recording thermometers that are accurate to ± 3 degrees Fahrenheit may be used in lieu

of indicating thermometers.

(2) Potentially hazardous food requiring refrigeration after preparation shall be cooled to an internal

temperature of 45 degrees Fahrenheit or below. Cooling of potentially hazardous foods shall be

initiated upon completion of the food preparation or hot storage. Methods such as pouring into pans,

agitation, and chilling with ice or water circulation external to the food containers shall be used to

cool potentially hazardous food. Potentially hazardous food that will be transported cold shall be

prechilled and held at a temperature of 45 degrees Fahrenheit or below.

(3) Ice used for cooling stored food and food containers shall not be used for human consumption.

(k) The following shall apply to the hot storage of food:

(1) Hot food storage equipment shall be provided in sufficient number and capacity to ensure the

maintenance of food at the required temperature during storage. Each hot food unit shall be provided

with a numerically scaled indicating thermometer that is accurate to ± 3 degrees Fahrenheit and

located to measure the air temperature in the coolest part of the unit. Recording thermometers that

are accurate to ± 3 degrees Fahrenheit may be used in lieu of indicating thermometers. Where it is

impractical to install thermometers on equipment such as steam tables, steam kettles, heat lamps,

cal-rod units, or insulated food transport carriers, a metal stem-type, thin probe, numerically scaled

indicating product thermometer that is accurate to ± 3 degrees Fahrenheit shall be used to check

internal food temperature.

(2) The internal temperature of potentially hazardous foods requiring hot storage shall be 135 degrees

Fahrenheit or above except during periods of preparation and service. Potentially hazardous food

that will be transported hot shall be held at a temperature of 135 degrees Fahrenheit or above during

transportation.

(l) In the event of a fire, flood, water supply interruption, power outage, or other event that results in the contamination

of food, or that might prevent potentially hazardous food from being held at required temperatures, the person in

charge shall either discard the food in question or contact the local health department for information on food safety.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991.

Amended Eff. February 1, 1995;

Temporary Amendment Eff. December 1, 1999;

Amended Eff. July 1, 2006; January 1, 2006; April 1, 2001;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2807 FOOD PREPARATION

(a) In child care centers, the preparation of food shall take place only in the kitchen or space equipped as required in

Rule .2810 of this Section.

(b) Employees engaged in food preparation in the kitchen shall wear clean clothes and hair restraints, as set out in

Part 2-402.11 of the Food Code incorporated by reference at 15A NCAC 18A .2650 as amended by 15A NCAC 18A

.2652, and shall keep their fingernails trimmed. Hair spray is not a hair restraint for the purpose of this Rule. Employees

engaged in food preparation who are wearing nail polish or artificial nails on their fingers shall wear intact gloves

during food preparation.

coming into direct contact with an employee's bare hands or exposed skin. Food shall be prepared on food-contact

surfaces that have been cleaned, rinsed, and sanitized prior to use. Food-contact surfaces and utensils that are exposed

to bacterial, viral, fungal, or hazard contaminants during use shall be made clean, free from hazards, and sanitized

before continued use.

(d) Raw fruits and raw vegetables shall be washed with potable water before being cooked or served.

(e) Potentially hazardous foods requiring cooking shall be cooked to heat all parts of the food to a temperature of at

least 145 degrees Fahrenheit, except that:

(1) poultry, poultry stuffings, stuffed meats and stuffings containing meat shall be cooked to heat all

parts of the food to at least 165 degrees Fahrenheit with no interruption of the cooking process;

(2) ground beef, other ground or comminuted meat or fish, and eggs pooled and cooked for hot storage

shall be cooked to an internal temperature of at least 155 degrees Fahrenheit with no interruption in

the cooking process; and

(3) roast beef shall be cooked to an internal temperature of at least 130 degrees Fahrenheit with no

interruption in the cooking process.

(f) Potentially hazardous foods that require cooking prior to consumption and cooked in a microwave oven shall be

heated to an internal temperature of at least 165 degrees Fahrenheit.

(g) Potentially hazardous foods that have been cooked and then refrigerated, if served above 45 degrees Fahrenheit,

shall be reheated to an internal temperature of 165 degrees Fahrenheit or higher before being served or before being

placed in a hot food storage unit except that commercially packaged food in intact packages may initially be reheated

to 135 degrees Fahrenheit. Hot storage equipment shall not be used for reheating of potentially hazardous foods.

Potentially hazardous foods reheated in a microwave oven shall be heated to an internal temperature of at least 165

degrees Fahrenheit.

(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.

(i) Potentially hazardous foods that are frozen shall be thawed using one of the following methods:

(1) in refrigerated units at a temperature not to exceed 45 degrees Fahrenheit;

(2) submerged under potable water of a temperature of 70 degrees Fahrenheit or below, with sufficient

water velocity to agitate and float off loose food particles into the overflow;

(3) in a microwave oven only when the food will be immediately transferred to conventional cooking

equipment as part of a continuous cooking process or when the entire, uninterrupted cooking process

takes place in the microwave oven; or

(4) as part of the uninterrupted cooking process.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. January 1, 2006; February 1, 1995; October 1, 1993;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2808 FOOD SERVICE

(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.

(b) Ice shall be protected against physical, chemical, and biological contamination and shall be kept clean. Ice shall

be dispensed with scoops, tongs, or other ice-dispensing utensils or through automatic ice-dispensing equipment.

Ice-dispensing utensils shall be stored on a clean surface or in the ice with the dispensing utensil's handle extended

out of the ice. Between uses, ice transfer receptacles shall be kept clean. Ice storage bins shall be drained through an

air gap in accordance with in Part 5-202.13 of the Food Code incorporated by reference at 15A NCAC 18A .2650 as

amended by 15A NCAC 18A .2655.

is not a potentially hazardous food. Foods that have been placed on the table for family style or self-serve food service

are considered served.

(d) Between uses during service, utensils that are used to serve food shall be stored in the food with the utensil handle

extended out of the food, in a container of water if the water is maintained at a temperature of at least 135 degrees

Fahrenheit, or stored clean and dry.

(e) Children shall not be in the kitchen except when participating in a supervised activity.

(f) Nothing in this Section shall be construed as prohibiting family style or self-serve food service at child care centers

provided that children are supervised by child care center employees for the duration of the meal. Notwithstanding

the foregoing sentence, family style or self-serve food service shall be prohibited during the outbreak and investigation

of a communicable disease or condition at the child care center.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff January 1, 2006; April 1, 1999; February 1, 1995;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2809 FOOD SERVICE EQUIPMENT AND UTENSILS

In child care centers, material, construction, and use of food service equipment and utensils shall meet the following

requirements:

(1) Utensils shall be made of nonabsorbent material that is free from hazards, finished to have a smooth

surface, and shall be kept clean and in good repair.

(2) Food-contact surfaces shall be smooth, nonabsorbent, free of sharp corners, and kept clean and in

good repair. Hard wood may be used for cutting boards, cutting blocks, or bakers' tables.

(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.

(4) Galvanized metal shall not be used for utensils, food-contact surfaces, or cooking equipment that

comes into contact with food.

(5) Linens shall not be used as food-contact surfaces, except that clean linen may be used in contact

with bread and rolls.

(6) Single-use and single-service articles shall be kept clean.

(7) Reuse of single-service articles is prohibited.

(8) Single-use articles shall be used only once, except that containers made of plastic, glass or other

material intended for food storage, with smooth sides may be reused.

(9) Water filters or any other water conditioning devices shall be kept clean and in good repair and shall

be maintained in accordance with the manufacturer's instructions.

(10) Filters and other grease extracting equipment shall be kept clean and in good repair and shall be

maintained in accordance with the manufacturer's instructions.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. January 1, 2006; February 1, 1995;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2810 SPECIFICATIONS FOR KITCHENS, FOOD PREPARATION AREAS AND

FOOD SERVICE AREAS

(a) Each child care center shall have at least a two-compartment sink, drainboards or countertop space of adequate

size, adequate refrigeration equipment and, when needed, adequate cooking equipment, except that this requirement

shall not apply to child care centers located in a school that receives food supplies that are pre-prepared and ready to

serve from a food service establishment permitted by a local health department, which is located at the same school

campus and provides food during all hours of the child care center's operation. Child care centers shall be permitted

to use domestic kitchen equipment. A child care center may use and wash multi-use articles and highchair feeding

trays in a two-compartment sink, but shall not use or wash multi-service articles other than highchair feeding trays

unless equipped with 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.

(b) A separate lavatory for handwashing is required in food preparation areas and kitchens. If the dishwashing area is

separate from the food preparation area, an additional handwashing lavatory shall be required in the dishwashing area.

review of construction plans, modifications, or change in child care procedures indicates that separate facilities are

needed based on volume and preparation frequency.

(d) Except in child care centers licensed for fewer than 13 children and located in a residence, when domestic

refrigeration equipment is used the following shall apply:

(1) except for thawing in a refrigerator, potentially hazardous foods shall not be prepared prior to the

day that such foods are to be served;

(2) potentially hazardous foods that have been heated shall not be reheated or placed in refrigeration to

be used in whole or in part on another day; and

(3) salads containing potentially hazardous food shall not be prepared on site. Prohibited salads include

chicken, egg, tuna, crab, and other salads containing meat.

(e) A commercial hood shall be installed in accordance with G.S. 110-91 when frying is used for food preparation

on-site at the child care center.

(f) If food is prepared in a child care center classroom, then the classroom shall be equipped with a food preparation

area. Water from a handwash lavatory shall not be used for bottle warming or to prepare formula, mix dry cereals, or

other foods. Toy cleaning and sanitizing may be conducted in the food preparation area. This food preparation area

shall contain a countertop that is kept clean and in good repair, a handwash lavatory, and refrigeration when items are

stored that require refrigeration in accordance with Rules .2804 and .2806 of this Section. The food preparation

counters, food, and food-contact surfaces shall be out of reach of children and the following shall apply to food

preparation counters, food, food-contact surfaces, and equipment used in food preparation:

(1) all equipment shall be kept clean. Bottle warming equipment shall be cleaned and sanitized as

required in Rule .2812 of this Section and the manufacturer's instructions;

(2) if bottles are warmed, bottles shall be warmed in the child care center's kitchen or food preparation

area. Bottle warming equipment shall be kept out of reach of children. Microwaves and slow cookers

shall not be used to thaw or warm human milk, baby food, formula, or other bottled beverages meant

for consumption by children. Bottles shall be warmed by placing bottles under running potable water

or in containers of potable water or by using bottle warming equipment that is used in accordance

with the manufacturer's instructions. Temperature restrictions listed in Rule .2815(e) of this Section

do not apply to equipment manufactured specifically for bottle warming. If other bottle warming

methods are used in food preparation areas, compliance with temperature restrictions listed in Rule

.2815(e) of this Section is required; and

(3) after each use, multi-service articles provided by the child care center shall be cleaned and sanitized

in the child care center kitchen.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. March 1, 1995;

Temporary Amendment Eff. April 15, 1998;

Amended Eff. April 1, 1999;

Temporary Amendment Eff. December 1, 1999;

Amended Eff. July 1, 2006; January 1, 2006; April 1, 2001;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2812 CLEANING, SANITIZING, AND DISINFECTING EQUIPMENT, UTENSILS,

AND OTHER AREAS

(a) Each child care center shall be equipped with adequate drainboards or countertop space for handling used utensils

and air drying clean and sanitized utensils. For child care centers originally licensed on or after April 15, 1998,

drainboards or countertop space shall be no less than 8 square feet. A domestic dishwasher may be used to provide

the equivalent of 4 square feet of drainboard space. Drainboards or countertop space designated for clean equipment

and utensils shall be on the opposite end of the sink from drainboards or countertop space designated for equipment

and utensils that are not clean, unless these areas are otherwise separated and protected from cross-contamination.

Child care centers originally licensed before April 15, 1998 shall comply with this Paragraph upon change of

ownership, the closing of the child care center and the issuance of a new license, or the remodeling of an existing

kitchen in a child care center.

(b) Except for fixed equipment and utensils too large to be cleaned in sink compartments, equipment and utensils that

are cleaned manually instead of in a dishwasher shall be washed, rinsed, and sanitized as follows, in the order of the

steps presented herein:

(1) equipment and utensils shall be scraped, flushed with water, or soaked with water to remove food

particles;

(2) sinks shall be cleaned and sanitized before proceeding to Subparagraph (3) of this Paragraph;

(3) equipment and utensils shall be washed in the first compartment of the sink with a hot detergent

solution that is changed once visibly soiled;

(4) equipment and utensils shall be rinsed free of detergent solution with clean water in the second

compartment of the sink; and

(5) the food-contact surfaces of equipment and utensils shall be sanitized in the third compartment of

the sink in the following manner:

(A) immersion for at least one minute in clean, hot water at a temperature of at least 170 degrees

Fahrenheit;

(B) immersion for at least two minutes in a solution containing 50 to 200 parts per million

(ppm) of chlorine at a temperature of at least 75 degrees Fahrenheit;

having a pH not higher than 5.0 and at a temperature of at least 75 degrees Fahrenheit;

(D) immersion for at least two minutes in a solution containing 200 to 400 ppm of quaternary

ammonium products and having a temperature of at least 75 degrees Fahrenheit, provided

that the quaternary ammonium product label indicates that it is effective in water that has

a hardness value at least equal to that of the water being used; or

(E) other sanitizing products, procedures, or equipment that are nontoxic to children, used

according to the manufacturer's instructions, are safe for use on food-contact surfaces, do

not require a final rinse step, and have a testing method.

and utensils shall be sanitized according to the dishwasher manufacturer's instructions. When a domestic dishwashing

machine with a sanitizing cycle is used according to manufacturer's instructions, additional sanitizing is not required.

When commercial dishwashing equipment is used, the dishwasher shall be equipped with a temperature indicating

device that is accurate to two degrees Fahrenheit.

(d) For fixed equipment and utensils and equipment that are too large to sanitize in a dishwashing machine or

dishwashing sink, a spray-on or wipe-on sanitizer of sufficient chemical strength as indicated in Subparagraph (b)(5)

of this Rule shall be used.

(e) Multi-service articles, including highchair feeding trays, shall be washed, rinsed and sanitized in the child care

center kitchen after each use.

(f) Kitchen surfaces that are not food-contact surfaces shall be kept clean.

(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.

(h) After sanitizing, all equipment and utensils shall be air dried.

(i) An approved disinfectant shall be provided for cleaning purposes. Throughout this Section, when an approved

disinfectant is used in a child care center, the manufacturer's Safety Data Sheets for the disinfectant product shall be

kept on file at the child care center and the instructions for use of the disinfectant product shall be followed. 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. To achieve the maximum germ reduction with a chlorine disinfecting solution, the surface

being disinfected shall be made wet with the chlorine disinfecting solution and allowed to air dry or be dried only after

the surface has been in contact with the chlorine disinfecting solution for a minimum of two minutes.

(j) A sanitizing solution shall be provided for cleaning purposes. Throughout this Section, when a sanitizing solution

is used in a child care center, the manufacturer's Safety Data Sheet shall be kept on file at the child care center and the

instructions for use of the sanitizing solution shall be followed. When a chorine solution is used in a child care center

it shall be prepared for use within 24 hours and a testing method or kit shall be used to ensure compliance with the

prescribed chlorine concentration. To achieve the maximum germ reduction with a chlorine solution, the cleaned

surfaces shall be left wet with the chlorine solution and allowed to air dry or be dried only after a minimum contact

time of at least two minutes.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. February 1, 1995; July 1, 1993;

Temporary Amendment Eff. December 1, 1999; April 15, 1998;

Amended Eff. July 1, 2006; January 1, 2006; April 1, 2001;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2814 FOOD SERVICE EQUIPMENT AND UTENSIL STORAGE

(a) In child care centers, food-contact surfaces, equipment, utensils, and single service articles shall be protected from

contamination.

(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.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. January 1, 2006; February 1, 1995;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2815 WATER SUPPLY

(a) A child care center's water supply shall meet the requirements of 15A NCAC 18C or 15A NCAC 18A .1700, as

applicable. The operator of a child care center using a groundwater supply that serves 25 or more people shall provide

the local health department serving the county in which the child care center is located with documentation from the

Department of Environmental Quality, Division of Water Resources, Public Water Supply Section that the well meets

the requirements of 15A NCAC 18C. In child care centers that use a non-community water supply, a water sample

shall be collected by the Department once a year and submitted to the North Carolina State Laboratory of Public

Health or other laboratory certified by the North Carolina State Laboratory of Public Health under 10A NCAC 42C

.0102 to perform bacteriological examinations.

The Department may collect additional samples for tests of water quality, as indicated by possible additional sources

of contamination.

(b) Water under pressure shall be provided to meet the child care center's needs of cooking, cleaning, drinking, toilets,

and outside uses.

.0102(c)(8). If the potential for back siphonage or backflow conditions exist, an atmospheric vacuum breaker or

backflow prevention device shall be installed.

(d) Water heating equipment shall be provided to meet the hot water requirements set forth in this Rule. The capacity

and recovery rates of water heating equipment shall be based on number and size of sinks, capacity of dishwashing

machines, capacity of laundering machines, diaper changing facilities, and other food service and cleaning needs for

child care centers not located in a residence. Child care centers licensed for fewer than 13 children and located in a

residence shall be allowed to use an existing water heater, or the equivalent replacement, if the water temperature

requirements set forth in this Rule are met. Hot and cold water under pressure shall be provided in all rooms where

food is prepared, rooms in which utensils or equipment are washed, and other areas where water is required for

cleaning and sanitizing, including diaper changing areas.

(e) Hot water used for cleaning and sanitizing utensils and laundry shall be provided at a minimum temperature of

120 degrees Fahrenheit at the point of use. Water in areas accessible to children shall be tempered between 80 degrees

Fahrenheit and 110 degrees Fahrenheit. Hot water that exceeds 120 degrees Fahrenheit is a burn hazard and shall not

be provided in areas accessible to children. For handwash lavatories used exclusively by school-age children, the

requirement to provide water tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit shall not apply. In

the event of the loss of hot water at the child care center, the operator shall immediately notify the local health

department that serves the county in which the child care center is located.

(f) Drinking fountains, if provided, shall be separate from handwash lavatories and kept clean. The water pressure of

a drinking fountain shall be regulated so that an individual's mouth does not come in contact with the nozzle and so

that water does not splash on the floor. Other devices used to dispense drinking water shall be kept clean.

(g) Outdoor drinking fountains shall be constructed to protect the spout from contamination by hazards and shall be

kept clean.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. February 1, 1995;

Temporary Amendment Eff. April 15, 1998;

Amended Eff. April 1, 1999;

Temporary Amendment Eff. December 1, 1999;

Amended Eff. July 1, 2006; January 1, 2006; April 1, 2001;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2816 LEAD POISONING HAZARDS IN CHILD CARE CENTERS

(a) In child care centers, areas accessible to children shall be free of identified lead poisoning hazards as defined

under G.S. 130A-131.7(7).

(b) The following actions shall be taken to ensure that drinking water in child care centers is free of identified lead

poisoning hazards as defined under G.S. 130A-131.7(7)(g).

(1) Child care operators, as defined under G.S. 110-86(7), shall test, once every three years, all water

outlets used for drinking or food preparation. Samples shall also be collected and tested within 30

calendar days of completion of any renovations or repairs that may impact the facility's drinking

water infrastructure, such as repair or replacement of all or part of drinking water service lines or

faucets, at impacted outlets. The operator shall provide documentation of testing results for review

by the Department during each unannounced routine sanitation inspection under Rule .2834(b) of

this Section.

(2) For child care centers that submit an application for licensure in accordance with 10A NCAC 09

.0302 after the effective date of this Rule, initial samples shall be collected by the child care operator

and tested in accordance with Subparagraph (b)(4) of this Rule during the license application

process.

(3) For all other centers, initial samples shall be collected by the child care operator and tested in

accordance with Subparagraph (b)(4) of this Rule within one year of the effective date of this Rule.

(4) The child care operator shall collect samples and submit them for testing in accordance with

guidance specified by the United States Environmental Protection Agency in its publication, 3Ts

for Reducing Lead in Drinking Water in Schools and Child Care Facilities, which is incorporated

by reference with subsequent changes or amendments and available free of charge at

https://www.epa.gov/ground-water-and-drinking-water/3ts-reducing-lead-drinking-water.

Notwithstanding the guidance, samples may be collected with a stagnation period of up to 72 hours.

Samples shall be analyzed by a laboratory certified by the North Carolina State Laboratory of Public

Health to analyze for lead in drinking water.

(5) When a water sample is analyzed for lead content by a laboratory under this Rule, the laboratory

shall notify the Department of the test results by electronic submission in accordance with G.S.

130A-131.8.

(6) When a child care center receives test results from a laboratory indicating that a water sample

collected by the child care operator contains a lead concentration at or above the lead poisoning

hazard level defined in G.S. 130A-131.7(7)(g), the child care operator shall:

(A) restrict access to any water outlet(s) used for drinking or food preparation that have lead

concentrations at or above the lead poisoning hazard level; and

(B) ensure that all children and staff have access to water free of cost that does not contain lead

concentrations at or above the lead poisoning hazard level for drinking and food

preparation.

(7) When notified of a water lead level at or above the lead poisoning hazard level, the Department shall

conduct sampling at the water outlet identified to have a water lead level at or above the lead

poisoning hazard level within 10 business days of notification.

(8) If a water sample collected by the Department reveals a water lead level at or above the lead

poisoning hazard level, the child care operator shall continue to follow Subparagraph (b)(6) of this

Rule until the Department determines the water outlet(s) are not producing water lead levels at or

above the lead poisoning hazard level and notifies the child care operator and the Division of Child

Development and Early Education in writing of this determination.

(9) Failure to comply with Paragraph (a) of this Rule or any Subparagraph of this Paragraph, shall be

deemed a violation of this Rule subject to demerits under Rule .2834(c)(20) of this Section.

(10) Within five business days of receiving the test results of the Department's water analysis that shows

a water lead level at or above the lead poisoning hazard level, the child care center operator shall

provide written notification of the test results to the parents or legal guardians of the children

attending the child care center and the staff of the child care center, in accordance with the United

States Environmental Protection Agency guidance specified in Subparagraph (b)(4) of this Rule.

(11) Within five business days of receiving the test results of the Department's water analysis that shows

a water lead level at or above the lead poisoning hazard level, the child care center operator shall

make the test results available to the public, free of charge. The child care center operator may post

test results to the child care center's website to satisfy the requirement to make the test results

available to the public.

History Note: Authority G.S. 110-91; 130A-131.5; 130A-131.7(7); 130A-131.8;

Eff. July 1, 1991;

Amended Eff. October 1, 2019; January 1, 2006; February 1, 1995;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2817 TOILETS

(a) In child care centers, toilet tissue paper shall be provided in each toilet room and stored in a clean, dry place. The

toilet room shall include or be adjacent to a handwash lavatory. Storage in toilet rooms shall be limited to toileting

and diapering supplies. All toilet fixtures shall be kept clean and in good repair. Toilet fixtures shall be child-sized,

adult-sized toilets that are adapted to accommodate children, or potty chairs.

(b) Toilet fixtures shall be cleaned and disinfected daily and when visibly soiled.

(c) If potty chairs are used, they shall be located and stored in a toilet room equipped with a spray-rinse toilet or utility

sink. Potty chairs shall be emptied, rinsed, cleaned and disinfected after each use.

(d) When cloth diapers are used and emptied, the diaper changing area shall be located next to a toilet room.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. July 1, 2006; January 1, 2006; April 1, 1999; February 1, 1995;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2818 LAVATORIES

(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.

(b) Lavatories shall be equipped with hot and cold water or tempered water provided through mixing faucets or

pre-mixing devices which provide water in the temperature range specified in Rule .2815(e) of this Section.

of use occurs when a handwash lavatory is used outside of its original intent. Change of use includes, but is not limited

to, a classroom handwash lavatory used for rinsing toothbrushes, a food preparation handwash lavatory used for toy

cleaning, or a classroom handwash lavatory used for diaper changing handwashing.

(d) Liquid soap and disposable towels or other hand-drying devices shall be provided at every handwash lavatory

area.

(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 of this Section.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. July 1, 2006; January 1, 2006; February 1, 1995;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2819 DIAPERING AND DIAPER CHANGING FACILITIES

(a) In child care centers, children in diapers shall be changed at stations designated for diapering or toileting. Each

diaper changing station shall include a handwash lavatory. For child care centers licensed for fewer than 13 children

and located in a residence, and for diaper changing areas designated for school age children, a handwash lavatory shall

be in or next to the diaper changing area.

(b) Diapering surfaces shall be made of smooth, intact, nonabsorbent material and shall be kept clean and in good

repair. Nothing shall be placed on the diapering surface except for those items required for diapering and the child

whose diaper will be changed. If diapering is performed on the floor in a toilet room, then a smooth, intact,

nonabsorbent barrier that is clean and in good repair shall be placed on the floor to minimize cross-contamination.

solution shall be kept in separate and labeled bottles at each diaper changing station. Approved disinfectants that are

chlorine disinfecting solutions shall be stored in hand pump spray bottles. No cloths or sponges shall be used on

diapering surfaces.

(d) Child care center employees shall change a child's diaper as follows:

(1) gathering supplies before placing child on diapering surface;

(2) donning disposable gloves (if needed);

(3) using disposable towelette or moistened paper towel to clean child, wiping front to back;

(4) disposing of gloves if used, soiled towelettes and diaper in a plastic-lined, covered receptacle;

(5) wiping the child care center employee's hands and the child's hands each with a separate disposable

towelette or moistened paper towel;

(6) sliding a clean diaper under the child, applying diapering products if needed, using facial or toilet

tissue, and discarding the tissue in a plastic-lined, covered receptacle;

(7) fastening the diaper and placing clothing on child;

(8) washing child's hands in accordance with Rule .2803 of this Section, or, if child is unable to support

the child's head, cleaning the child's hands with a disposable towelette or moistened paper towel,

then drying the child's hands and returning the child to a supervised area;

(9) spraying entire diapering surface with detergent solution and wipe clean, using disposable paper

towels;

(10) spraying entire diapering surface with an approved disinfectant and allowing to remain on the

surface for two minutes or as specified by the manufacturer, or air dry; and

(11) washing hands in accordance with Rule .2803 of this Section even if disposable gloves are used by

the child care center employee.

(e) Vinyl or latex disposable gloves shall be used by child care center employees during the diaper changing process

if the employee's hands have cuts, sores, or chapped skin.

(f) Child care center employees may dispose of feces from diapers in the toilet, but shall not rinse soiled cloth diapers,

training pants, or clothes. Soiled cloth diapers, training pants, or clothes shall be sent to a diaper service or placed in

a sealed plastic bag or other sealed container, stored out of reach of children, and sent home with the child on the same

day to be laundered.

(g) Receptacles containing soiled disposable diapers shall be emptied in a garbage area located outside the child care

center building daily.

(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.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. February 1, 1995;

Temporary Amendment Eff. April 15, 1998;

Amended Eff. July 1, 2006; January 1, 2006; April 1, 1999;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2820 STORAGE

(a) In child care centers, adequate space shall be provided for the storage of equipment, furniture, toys, clothes, linens,

backpacks, book bags, diaper bags, beds, cots, mats, and supplies. Storage areas shall be kept clean. Laundry that is

not clean shall be handled and stored separately from clean laundry using separate containers that are made clean in

between uses and kept in good repair.

(b) Toxic substances, which include 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 shall be kept in the original container or in another labeled container, used according to the

manufacturer's instructions, and stored in a locked storage room or cabinet when not in use. Locked storage rooms

and cabinets shall include those which are unlocked with a combination lock, electronic or magnetic device, keypad,

key, or equivalent locking device. Keys and electronic or magnetic unlocking devices shall be kept out of the reach of

a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and

food. Any other product that is labeled "keep out of reach of children" and does not have any other warnings on the

label shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. For the

purpose of Paragraphs (b), (c), and (d) of this Rule, 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.

shall be kept inaccessible to children when not in use, but are not required to be in locked storage. These solutions

shall be labeled as sanitizing, disinfecting, or detergent solutions. Hand soap other than that which is in bulk containers

is not required to be kept inaccessible to children or in locked storage. Bulk soaps shall be kept inaccessible to children.

(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. Designated emergency medications shall be kept inaccessible to children,

but are not required to be in locked storage. 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.

(e) A locked kitchen is not considered to be a locked storage room or cabinet for the purposes of this Rule; however,

for child care centers that are located within a school and that use the school cafeteria's kitchen to meet the kitchen

requirements of the rules of this Section, it shall not be a violation of this Rule to store products described in Paragraphs

(a)-(d) of this Rule unlocked in the cafeteria's kitchen, provided that the kitchen is kept locked and children are not

permitted in the kitchen for any purpose.

(f) Individual cubicles, lockers, or coat hooks shall be provided for storage of coats, hats, bags, or other items and

accessories. Coat hooks not in individual cubicles or lockers, shall be spaced at least 12 horizontal inches apart. A

child's coats, hats, bags, and other items or accessories belonging to a child that are stored using cubicles, lockers, or

coat hooks shall not come into contact with stored items belonging to other children. Combs shall be labeled with the

name of the child to whom the comb belongs and stored separately from combs or other items that belong to a different

child. Toothbrushes shall be labeled with the name of the child to whom the toothbrush belongs, allowed to air dry

after use, protected from contamination, and stored in a designated area. When a container of toothpaste is used for

multiple children, the toothpaste shall be dispensed onto an intermediate surface such as waxed paper and shall not be

dispensed directly onto each child's toothbrush.

(g) 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.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. July 1, 2006; January 1, 2006; April 1, 1999; February 1, 1995;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS

(a) In child care centers, beds, cribs, cots, mats, and play pens shall be kept clean and in good repair, stored to prevent

contamination, and cleaned and sanitized between users.

(b) Cribs and play pens used for sleeping shall be kept clean and equipped with a firm, tight-fitting mattress made of

waterproof, washable material at least two inches thick.

linens.

(d) Mats shall be of a waterproof, washable material at least two inches thick and shall be stored so that the side of

the mats that makes contact with the floor does not touch the side of a mat that any child sleeps on. The sleeping

surface of one child's mat shall not come in contact with the sleeping surface of another child's mat during storage.

(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.

(f) Linens shall be kept clean, in good repair, and stored with the mat or cot that the linens are assigned to or stored

apart from the mattress or cot in a manner that keeps the linens used for each child separate from the linens belonging

to other children. Linens shall be laundered between users, when soiled, and otherwise once per week. 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. Linens shall be large enough to cover the bed, cot, or mat's sleeping surface.

(g) Wash cloths, bibs, and burping cloths shall be laundered after each use. Each time a wash cloth, bib, or burping

cloth is used, it shall be used for only one child.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. July 1, 2006; January 1, 2006; February 1, 1995;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2822 TOYS, EQUIPMENT AND FURNITURE

(a) Toys, equipment, and furniture provided by a child care center shall be kept clean and in good repair. 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.

(b) Toys and other mouth-contact surfaces that are not designed to be submerged in liquid shall be washed and rinsed

in place, sprayed with a sanitizing solution, and allowed to air dry. Hard plastic toys may be washed and rinsed in a

dishwasher and cloth toys may be laundered and mechanically dried without requiring sanitizing.

(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. 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. Wading pools are not considered water play centers and are regulated under the rules in Section

.2500 of this Subchapter.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. February 1, 1995; July 23, 1992;

Temporary Amendment Eff. April 15, 1998;

Amended Eff. July 1, 2006; January 1, 2006; April 1, 1999;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2823 PERSONNEL

(a) In child care centers, employees shall wear clean clothing while at work. Employees shall keep their fingernails

clean.

(b) Tobacco use in any form is prohibited in any part of a child care center.

of this Section.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. February 1, 1995;

Temporary Amendment Eff. April 15, 1998;

Amended Eff. January 1, 2006; April 1, 1999;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2824 FLOORS

(a) In child care centers, floors and floor coverings in food preparation, food storage, utensil washing, toilet rooms,

and laundry areas shall be constructed of nonabsorbent material and shall be kept clean and in good repair.

(b) Floors and floor coverings in sleeping and play areas shall be kept clean and in good repair.

repair. Carpeted floors shall be vacuumed daily when children are not present in the room, except to clean up spills.

Instead of waiting for children to leave the room, a High Efficiency Particulate Air (HEPA) filter vacuum cleaner may

be used. If used for this purpose, a HEPA vacuum cleaner shall include a HEPA filter individually tested and rated as

99.97% efficient at 0.3 micron dust particle size and sealed to prevent leakage around connecting points. Vacuum

bags shall be changed and vacuums shall be emptied when children are not present in the room. The vacuum cleaner

shall be in good repair. Wall to wall carpets shall be cleaned using extraction methods at least once each six months.

Cleaning materials including surfactants, solvents, and water used for extraction shall be removed from the carpet

before the space is reoccupied. When water extraction is used, the carpet shall be completely dry within 12 hours of

cleaning.

(d) Floors in areas accessible to children, shall be kept free of peeling, flaking, chalking, or otherwise deteriorating

paint.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. January 1, 2006; April 1, 1999; February 1, 1995; July 23, 1992;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2825 WALLS AND CEILINGS

(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.

(b) Walls and ceilings in rooms in which food is stored, handled, or prepared, utensil-washing rooms, and toilet rooms

shall be nonabsorbent. Acoustic and other absorbent ceiling material may be used where ventilation in the room

precludes the possibility of grease and moisture absorption by the acoustic or other material. For child care centers

licensed for fewer than 13 children and located in a residence, ceilings of residential construction are acceptable if

kept clean and in good repair.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. April 1, 1999; July 23, 1992;

Temporary Amendment Eff. December 1, 1999;

Amended Eff. January 1, 2006; April 1, 2001.

Readopted Eff. July 1, 2023.

15A NCAC 18A .2826 LIGHTING AND THERMAL ENVIRONMENT

(a) In child care centers, all rooms and enclosed areas shall be lighted by natural or artificial light. Lighting shall be

capable of illumination to at least 50 foot-candles at work surfaces. Lighting shall be capable of illumination to at least

10 foot-candles of light, at 30 inches above the floor, in all other areas, including storage rooms. Light fixtures in all

areas shall be kept clean and in good repair. Shielded or shatterproof bulbs shall be used in food preparation, storage,

and serving areas and in all rooms used by children.

(b) All rooms used by children shall be heated, cooled, and ventilated to maintain an ambient temperature between

65 degrees Fahrenheit and 85 degrees Fahrenheit. Ventilation may be in the form of openable windows with screens

or by means of mechanical ventilation to the outside of the building. Windows and window treatments shall be kept

clean and in good repair. All ventilation equipment, including air supply diffusers, return grilles, and fans shall be

kept clean and in good repair.

(c) Nothing in the rules of this Section shall require that outdoor storage buildings be wired with electricity or provided

with heating and air conditioning.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. January 1, 2006; February 1, 1995;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2827 COMMUNICABLE DISEASES AND CONDITIONS

(a) In child care centers, a child who becomes ill to the extent that the child can no longer participate in routine group

activities shall be separated from the other children until the child leaves the child care center and in accordance with

10A NCAC 09 .0804.

(b) Each child care center shall include a designated area for a child who becomes ill to the extent that she or he can

no longer participate in the routine group activities. When in use, such area shall be equipped with a bed, cot, or mat

and a vomitus receptacle and shall be cleaned and disinfected after each use. Thermometers and all materials used in

the designated area, including toys, shall be cleaned and sanitized after each use. Linens shall be changed after each

use.

from space used by other children by a partition or screen. The designated area shall be located so that health and

sanitation measures can be carried out without interrupting activities of other children and staff.

(d) The child care center shall have written procedures that employees shall follow when responding to vomiting or

diarrheal events that involve the discharge of vomitus or fecal matter onto surfaces in the center. The procedures shall

address the specific actions employees must take to minimize the spread of contamination and the exposure of

employees, children, food, and surfaces to vomitus or fecal matter. The written procedures shall include the following

information:

(1) Child care center employees who are part of the designated clean up response team;

(2) A supply list for vomit and diarrhea cleanup kit items that shall be kept on-site at the child care

center, including:

(A) disposable personal protective equipment (gloves, apron, mask, shoe covers, and hair

restraint);

(B) two disposable plastic bags;

(D) a scoop or scraper;

(E) a mop and bucket; and

(F) an approved disinfectant;

(3) The location of the supplies described in Subparagraph (d)(2) of this Rule;

(4) A procedure for preventing access to the contaminated area;

(5) The steps used to clean and disinfect the contaminated area, which shall include the following:

(A) for hard surfaces, remove the vomit or diarrhea, wash the contaminated surface, and use an

approved disinfectant.

(B) for carpet or upholstery, remove the vomit or diarrhea without use of vacuum, wash all

surfaces, and steam clean or use an approved disinfectant.

(6) The steps for after clean up, which shall including the following:

(A) throw away all items that came into contact with the vomit or diarrhea;

(B) remove all personal protective equipment (PPE);

(D) disinfect non disposable cleaning items such as scoops, scrapers, mop heads, mop handles,

and buckets and discard of disposable cleaning items; and

(E) wash hands in accordance with the procedures in Rule .2803(e) of this Section.

(7) Identify steps for properly storing contaminated articles of clothing and cloth diapers that came into

contact with the vomit or diarrhea in accordance with the procedures in Rule .2819(f) of this Section.

(e) Employees with a communicable disease or a communicable condition shall be excluded from work or subject to

restrictions to prevent transmission in accordance with the Rules in Section 10A NCAC 41A .0200. Any employee

with boils, sores, burns, infected wounds, or other draining lesions on exposed skin shall bandage the affected area to

avoid exposing others to drainage. If such bandaging obstructs handwashing as set out in Rule .2803 of this Section,

if the exposure to drainage cannot be prevented, or if otherwise required under the rules in Section 10A NCAC 41A

.0200, then the employee shall be excluded from food preparation and work activities that involve contact with other

employees or children while risk of transmission of the communicable disease or condition exists.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. February 1, 1995;

Temporary Amendment Eff. April 15, 1998;

Amended Eff. January 1, 2006; April 1, 1999;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2829 WASTEWATER

In child care centers, all wastewater originating from the child care center shall be disposed of using a publicly-

operated sewage treatment system or an individual sewage disposal system that meets the requirements of the rules at

Section .1900 of this Subchapter. Septic systems shall be of adequate size to accommodate the wastewater needs of

the anticipated number of children and staff for all shifts.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. January 1, 2006; April 1, 1999; February 1, 1995;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2830 SOLID WASTES

(a) In child care centers, food scraps and other putrescible materials shall be placed in a plastic-lined, cleanable,

covered container and removed to an exterior garbage area daily. Scrap paper, cardboard boxes, and other recyclable

items shall be stored in containers or designated recycling areas.

(b) Solid waste containers, mops, and other cleaning equipment shall be kept clean when not in use. Facilities shall

be provided at the child care center for the washing and storage of solid waste containers and mops, except that such

facilities shall not be required for child care centers licensed for fewer than 13 children and located in a residence.

Washing facilities required under this Paragraph shall include a faucet with a threaded nozzle that delivers water of at

least 80 degrees Fahrenheit. The faucet shall be located in either a designated utility sink or above a curbed impervious

pad that is sloped to drain into a system that meets the requirements of Rule .2829 of this Section. Washing facilities

used for solid waste containers that were installed at the child care center prior to July 1, 1991 shall be permitted to

be used if the facilities are in good repair.

(d) Solid wastes shall be disposed of to prevent conditions that attract and harbor pests and other public health

nuisances.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. February 1, 1995;

Temporary Amendment Eff. April 15, 1998;

Amended Eff. January 1, 2006; April 1, 1999;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2831 ANIMAL AND VERMIN CONTROL

(a) Animals that are not contained in a cage or restrained on a leash, except those used in supervised activities or pet

therapy programs, shall not be allowed in a child care center, including the outdoor learning environment. When

animals are on the child care center premises, copies of each animal's vaccination records shall be available for review

upon request during a sanitation inspection of the child care center. Any animals kept at the child care center as pets

shall be examined by a veterinarian to determine that they are free from pests and pathogens that could adversely

affect human health. Turtles, iguanas, frogs, salamanders, and other reptiles or amphibians shall not be kept as pets

on the child care center premises. Animals shall not be allowed in or kept at the entrances to food preparation areas.

Animal cages shall be kept clean and animal waste materials shall be bagged, sealed, and immediately disposed of in

the child care center's exterior garbage area in a covered container. Animals belonging to child care center owners,

employees, volunteers, visitors, and children shall not be allowed in child care centers or on the premises unless the

requirements set forth in this Paragraph are met.

(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.

(c) All openings to the area outside of the child care center shall be protected against the entrance of flying pests. In

food preparation areas, only fly traps, pyrethrin-based insecticides, or a fly swatter shall be used for extermination of

flying pests. Products shall be used only in accordance with directions and cautions appearing on their labels.

Insecticides shall not come in contact with raw or cooked food, utensils, or equipment used in food preparation and

serving, or with any other food-contact surface.

(d) Only those pesticides which have been registered in accordance with 40 C.F.R. 152 and G.S. 143-442 shall be

used to control pests at a child care center. Pesticides shall be used in accordance with the directions on the label and

shall be stored in a locked storage room or cabinet separate from foods and medications. Pesticides shall not be applied

or used when children are present in the area.

(e) Decks, fences, playground equipment, and other products constructed or installed after September 1, 2006 shall

not be made from chromated copper arsenate (CCA) pressure-treated wood unless the use of CCA-treated wood is for

an approved use listed on the CCA product label.

(f) In areas accessible to children, CCA-treated wood decks, playground and recreational equipment, and structures

installed or constructed shall be sealed using an oil-based, semi-transparent sealant; oil-based clear stain; or a water-

based clear stain applied at least once every two years.

(g) At the time of the initial sealant or stain application and whenever more than two years has passed since the

previous sealant application, soil under CCA-treated wood shall be:

(1) removed and replaced with similar material;

(2) covered with at least four inches of soil, gravel, sand, sod, or other vegetation; or

(3) otherwise made inaccessible to children.

(h) Any composting areas shall be covered and maintained to prevent attracting pests. Worm bins shall be kept

covered.

(i) Grass, fruit and vegetable gardens, vines on fences, and other vegetation shall be maintained to prevent the

harboring and breeding of pests.

(j) Pets kept outdoors at a child care center shall be in a designated area that is maintained and separate from the

outdoor area used by the children.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Temporary Amendment Eff. April 15, 1998;

Amended Eff. August 2, 2007; January 1, 2006; April 1, 1999;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2832 OUTDOOR LEARNING ENVIRONMENT AND PREMISES

(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. Debris, glass, dilapidated structures, and broken play equipment shall be removed from areas accessible

to children. Wells, grease traps, cisterns, and utility equipment shall be made inaccessible to children.

(b) Sand toys, water tables, and other unfiltered items that can collect standing water in the outdoor learning

environment shall be emptied and stored to prevent the collection of standing water.

(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.

(d) Children's outdoor activities shall be restricted as set forth in this Paragraph based on a daily air quality forecast

made by the North Carolina Department of Environmental Quality, Division of Air Quality for the county where a

center is located and published on the Division of Air Quality's Air Quality Portal at:

https://airquality.climate.ncsu.edu/air-guide/aq-datasets/. On days with a code orange (unhealthy for sensitive groups)

forecast, children shall not be outside participating in physical activity between noon and 8:00 p.m. for more than one

hour. On days with a code red (unhealthy) forecast, children shall not be outside participating in physical activity

between noon and 8:00 p.m. for more than 15 minutes. On days with a code purple (very unhealthy) forecast, children

shall not be outside participating in physical activity between noon and 8:00 p.m. Provisions shall be made to allow

children with diagnosed asthma or with coughing or wheezing symptoms to participate in physical activity indoors on

days with a code orange, red or purple air quality forecast.

(e) When food service is provided in the outdoor learning environment, food shall be protected, stored, prepared, and

served in accordance with Rules .2806, .2807 and .2808 of this Section. Employees and children shall wash their hands

in accordance with Rule .2803 of this Section prior to food service in the outdoor learning environment and food

service tables shall be cleaned or covered prior to use.

(f) When diapering and toileting facilities are provided in the outdoor learning environment, they shall be maintained

in accordance with Rules .2817 and .2819 of this Section and employees and children shall wash their hands in

accordance with Rule .2803 of this Section.

(g) Storage provided in the outdoor learning environment for children's toys shall be kept clean and in good repair.

Storage areas that are accessible to children shall be kept free of equipment that is not intended by the manufacturer

to be used by children and shall meet the requirements of Rule .2820 of this Section. Storage areas shall meet

requirements for lighting in accordance with Rule .2826 of this Section. Spare batteries shall be kept on-site at the

child care center for battery operated light fixtures used to light storage areas in accordance with this Paragraph.

(h) Outdoor water play centers shall be maintained in accordance with Rule .2822 of this Section.

(i) Central vacuums that exhaust to the outdoors and away from where children use the outdoor learning environment

may be used in lieu of HEPA vacuum cleaners to meet the daily vacuuming requirements in Rule .2824(c) of this

Section.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. July 1, 2006; January 1, 2006; April 1, 1999; July 23, 1992;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2833 SWIMMING AND WADING POOLS

(a) At child care centers, swimming and wading pools shall be designed, constructed, operated, and maintained in

accordance with the rules in Section .2500 of this Subchapter.

(b) Portable wading pools, natural bodies of water, and unfiltered water that is not potable shall not be utilized for

children's recreation activities.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. February 1, 1995; January 1, 1992;

Temporary Amendment Eff. April 15, 1998;

Amended Eff. January 1, 2006; April 1, 1999;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2834 COMPLIANCE, INSPECTIONS AND REPORTS

(a) Upon receipt of a request from a child care center operator or the licensing agency, a sanitation inspection shall

be conducted of that child care center by the local health department that serves the county in which the child care

center is located within 30 calendar days of receipt of the request.

(b) Unannounced inspections of a child care center shall be made by the Department at least once each six-month

period. An original and two copies of the form used to document the inspection shall be completed by the Department.

The original shall be submitted by the Department to the licensing agency and the child care center operator and the

Department shall each retain a copy.

licensing agency. Demerits taken during the sanitation inspection shall be assigned for violations of the rules of this

Section as follows:

(1) violation of Rules .2803(a)-(d) or .2836(15) of this Section related to handwashing when required

shall be assessed five demerits;

(2) violation of Rule .2803(e) of this Section related to proper handwashing procedures shall be assessed

five demerits;

(3) violation of Rule .2804 of this Section related to food that is not from an approved source or that is

from approved sources that is a hazard or is adulterated shall be assessed six demerits;

(4) violation of Rules .2804, .2806, or .2807 of this Section related to potentially hazardous food that

does not meet temperature storage and holding requirements and requirements regarding the

refrigeration of bottles and lunches at 45 degrees Fahrenheit or below shall be assessed six demerits;

(5) violation of Rules .2804, .2806, .2807, .2808, or .2836 of this Section related to food being properly

stored, thawed, prepared, cooked, cooled, handled, served, transported, packaged, and identified,

and only permitting supervised children in the kitchen shall be assessed five demerits;

(6) violation of Rule .2808(c) of this Section related to food not re-served shall be assessed three

demerits;

(7) violation of Rule .2806 or .2807 of this Section related to the use of food thermometers and food

thermometer accuracy shall be assessed two demerits;

(8) violation of Rules .2809 or .2810 of this Section related to food service equipment and utensils and

specifications for refrigeration, sinks, lavatories, and dishwashing equipment shall be assessed six

demerits;

(9) violation of Rules .2806, .2809, or .2810 of this Section related to food service equipment and

utensils meeting approved material, and construction specifications for equipment and utensils,

other than equipment described in Subparagraph (c)(8) of this Rule, shall be assessed four demerits;

(10) violation of Rules .2809 or .2812 of this Section related to food-contact surfaces being properly

washed, rinsed, sanitized, and air dried and single-service articles not being re-used shall be assessed

five demerits;

(11) violation of Rule .2812 of this Section related to a sanitizing solution being provided and a test kit

being available shall be assessed two demerits;

(12) violation of Rule .2809, .2810, or .2812 of this Section related to keeping equipment and non-food-

contact surfaces clean and in good repair shall be assessed four demerits;

(13) violation of Rule .2814 of this Section related to proper storage and handling of clean equipment,

utensils, and single-service articles shall be assessed three demerits;

(14) violation of Rule .2815 of this Section related to water supply and drinking water facilities and

documentation that water supplies and facilities satisfy the applicable regulatory requirements shall

be assessed six demerits;

(15) violation of Rule .2815 of this Section related to hot water supplied and maintained in the kitchen

shall be assessed six demerits;

(16) violation of Rule .2815 of this Section related to hot water supplied and tempered water maintained

as required in all other areas shall be assessed four demerits;

(17) violation of Rule .2815(e) of this Section related to hot water in excess of 120 degrees Fahrenheit

not allowed in areas accessible to children shall be assessed six demerits;

(18) violation of Rule .2815(c) of this Section related to backflow prevention and cross connections shall

be assessed three demerits;

(19) violation of Rules .2815(c) or .2836 of this Section related to drinking fountain construction and

location, water pressure regulation, and drinking fountains being kept clean shall be assessed two

demerits;

(20) violation of Rule .2816 of this Section related to identified lead poisoning hazards shall be assessed

six demerits;

(21) violation of Rules .2817, .2818, or .2836 of this Section related to toilet and lavatory facilities being

properly sized, located, accessible, and in good repair, and sinks, toilets, and potty chairs being

cleaned and disinfected shall be assessed four demerits;

(22) violation of Rules .2817 or .2818 of this Section related to the provision of soap, disposable towels,

hand drying devices, and toilet tissue paper shall be assessed three demerits;

(23) violation of Rules .2817 or .2818 of this Section related to storage in toilet rooms, lavatories being

kept free of storage, and handwash signs being posted shall be assessed two demerits;

(24) violation of Rules .2817, .2819, or .2836 of this Section related to the set-up of diaper changing

facilities shall be assessed six demerits;

(25) violation of Rule .2819 of this Section related to diapering surfaces being cleaned and disinfected

after each use shall be assessed six demerits;

(26) violation of Rule .2812 or .2819 of this Section related to an approved disinfectant being provided

and a test kit being available when required shall be assessed two demerits;

(27) violation of Rules .2818, .2819, or .2820 of this Section related to diaper changing facilities being

kept free of storage and in good repair, detergent solutions and approved disinfectants being labeled,

required diapering methods being used, and diaper changing and handwash signs being posted shall

be assessed four demerits;

(28) violation of Rule .2820(d) and (g) of this Section related to medications being properly stored shall

be assessed six demerits;

(29) violation of Rule .2820(b) and (e) of this Section related to hazardous products being properly stored

and locked shall be assessed six demerits;

(30) violation of Rule .2820(c) of this Section related to non-hazardous products being properly stored

shall be assessed three demerits;

(31) violation of Rule .2820 of this Section related to facilities being provided for proper storage, and

storage being kept clean shall be assessed two demerits;

(32) violation of Rules .2821 or .2836 of this Section related to individual linen being provided and

adequate beds, cots, or mats being provided, kept in good repair, properly stored, labeled, and spaced

during use shall be assessed three demerits;

(33) violation of Rule .2821 of this Section related to linen, wash cloths, bibs, and burping cloths being

laundered and kept in good repair shall be assessed three demerits;

(34) violation of Rules .2822 or .2836 of this Section related to toys, equipment, and furniture being kept

clean and in good repair and the cleaning, sanitization, and maintenance of water play centers shall

be assessed four demerits;

(35) violation of Rules .2822 or .2836 of this Section related to mouth-contact surfaces in rooms

designated for children who are not toilet trained being cleaned and sanitized in rooms where

children who are not toilet trained are cared for shall be assessed four demerits;

(36) violation of Rules .2807 or .2823 of this Section related child care center employees wearing gloves,

clean clothes, and hair restraints where required, and tobacco use shall be assessed two demerits;

(37) violation of Rules .2824, .2825, or .2836 of this Section related to floors, walls and ceilings being

kept clean and in good repair and the vacuuming and extraction cleaning of carpets shall be assessed

four demerits;

(38) violation of Rule .2826 of this Section related to the lighting and thermal environment and room

temperature being kept between 65 degrees Fahrenheit and 85 degrees Fahrenheit shall be assessed

three demerits;

(39) violation of Rule .2826 of this Section related to lighting and thermal equipment being kept clean

and in good repair and being maintained as required shall be assessed two demerits;

(40) violation of Rule .2827(e) of this Section related to persons with a communicable disease or a

condition shall be assessed six demerits;

(41) violation of Rules .2827 or .2836 of this Section related to persons caring for mildly sick children

or ill children being excluded from situations in which transmission of communicable disease can

be expected to occur and proper written procedures being followed for vomiting or diarrheal events

shall be assessed four demerits;

(42) violation of Rule .2827 of this Section related to the designated area for sick children maintained as

required and written procedures for responding to vomiting or diarrheal events shall be assessed two

demerits;

(43) violation of Rule .2829 of this Section related to sewage disposal shall be assessed six demerits;

(44) violation of Rules .2830 or .2836 of this Section related to solid waste being properly handled, solid

waste containers and cleaning equipment kept clean, and the provision of adequate solid waste can

washing facilities shall be assessed two demerits;

(45) violation of Rule .2831 of this Section related to pesticides being properly used and new installation

of CCA pressure-treated wood shall be assessed six demerits;

(46) violation of Rule .2831 of this Section related to CCA pressure-treated wood being sealed and soil

being covered or made inaccessible as required shall be assessed two demerits;

(47) violation of Rule .2831 of this Section related to animals in food preparation areas and restrictions

on unrestrained or prohibited animals shall be assessed three demerits;

(48) violation of Rules .2831 or .2832 of this Section related to pest control and the child care center

premises being free of conditions that harbor or attract pests shall be assessed three demerits;

(49) violation of Rule .2832 of this Section related to outdoor premises being kept clean and free of

standing water and wells, grease traps, cisterns, and other utility equipment being kept inaccessible

to children, outdoor equipment and toys being kept clean and in good repair, sandboxes being

properly constructed and kept clean, and adherence to air quality forecast outdoor activity

restrictions shall be assessed two demerits; and

(50) violation of Rule .2833 of this Section related to swimming and wading pools being designed,

constructed, operated, and maintained in accordance with the rules at Section .2500 of this

Subchapter shall be assessed six demerits.

(d) The Department shall indicate on the sanitation inspection form whether the child care center is classified as

"superior," "approved," "provisional," or " disapproved" based on the sanitation inspection and the resulting score

based on demerits taken in accordance with Paragraph (e) of this Rule. A sanitation classification placard that lists the

child care center's score and classification shall be posted in the child care center in a location designated by the

Department and where the placard can be seen by the public upon entry to the child care center. A summary

classification of "disapproved" shall be issued by the Department and forwarded to the licensing agency when the

Department's right-of-entry to inspect the child care center is denied or when an inspection is discontinued at the

request of the operator or child care center administrator, unless the decision to discontinue the inspection is mutually

made by the child care center operator or administrator and the Department. A summary classification of

"disapproved" shall also be issued by the Department and forwarded to the licensing agency when a water sample that

is collected pursuant to Rule .2815 of this Section is confirmed positive for fecal coliform, total coliform, or other

chemical constituents in accordance with Rule .1725 of this Subchapter.

(e) A child care center's level of compliance with the Rules of this Section is indicated by the number of demerits

listed on the sanitation inspection form and the following shall apply for a child care center's classification:

(1) When an inspection is requested and conducted for the purpose of issuing a license to a new operator,

a completed sanitation inspection shall be forwarded by the Department to the licensing agency only

when the child care center is granted a "superior" classification.

(2) If the child care center is not yet in operation and children are not in attendance when the initial

sanitation inspection is conducted, a sanitation inspection form shall be completed by the

Department and forwarded to the licensing agency but the placard listing the child care center's

sanitation classification shall not be posted in the child care center. Another sanitation inspection

shall be conducted by the Department when children are in attendance at the child care center and

within 30 days of the child care center opening. The placard listing the sanitation classification

earned by the child care center during the most recent inspection shall be posted following this

second sanitation inspection and in accordance with Paragraph (d) of this Rule. When a temporary

license is issued by the licensing agency to a child care center as a result of a change of ownership

in a child care center and the child care center continues to operate, the operator shall request an

inspection from the Department within 14 days of the issuance of the temporary license. After the

sanitation inspection is completed, a placard listing the child care center's sanitation classification

shall be posted.

(3) A child care center shall be classified as "superior" if the demerit score does not exceed 15 and no

6-point demerit item is violated.

(4) A child care center shall be classified as "approved" if the demerit score is more than 15 and does

not exceed 30, and no 6-point demerit item is violated.

(5) A child care center shall be classified as "provisional" if any 6-point demerit item is violated or if

the total demerit score is more than 30 but does not exceed 45. The provisional classification period

shall not exceed seven days unless construction or renovation is necessary to correct any violation,

in which case the Department may specify a longer provisional classification period. At the end of

the provisional classification period, a follow-up inspection shall be conducted by the Department

and a new demerit score and classification shall be issued.

(6) A child care center shall be classified as "disapproved" if the demerit score is more than 45, or if

conditions and violations which resulted in a "provisional" classification have not been corrected in

the time period specified by the Department in accordance with Subparagraph (e)(5) of this Rule.

(7) If the child care center receives a "disapproved" classification, the Department shall immediately

notify the licensing agency of the classification.

(8) The placard listing the child care center's sanitation classification shall not be removed from the

location designated by the Department under Paragraph (d) of this Rule except by or upon the

instruction of the Department.

(f) The Department may conduct an additional inspection of any child care center that is issued a "provisional,"

"disapproved," or summary "disapproved" classification or upon receipt of a complaint about the sanitation of a child

care facility that is made to the Department to ensure compliance with the Rules in this Section.

(g) The Department shall document demerits for violations of the rules of this Section on an inspection form and a

written explanation and corrective action for each violation shall be documented on a comment addendum to the form.

The inspection form shall contain the following minimum elements:

(1) The date and purpose of the inspection;

(2) The child care center's name, address, license number, operating status, and maximum capacity;

(3) The name of the operator of the child care center;

(4) Documentation of violations observed during the inspection, demerits, and classification;

(5) Documentation of the type of water supply and wastewater system serving the child care center and

whether water samples were taken during the inspection; and

(6) The name of the inspector's employer, if completed by an authorized agent, and the inspector's

signature.

(h) Demerits may be assessed only once for a single occurrence or condition existing within or outside the child care

center. Demerits shall be assessed based on actual violations of the Rules of this Section observed during the

inspection.

History Note: Authority G.S. 110-88; 110-91;

Eff. July 1, 1991;

Amended Eff. February 1, 1995;

Temporary Amendment Eff. April 15, 1998;

Amended Eff. July 1, 2006; January 1, 2006; April 1, 1999;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2835 APPEALS PROCEDURE

Appeals concerning the enforcement of the Child Care Sanitation Rules in this Section as adopted by the Commission

for Public Health shall be governed by G.S. 110-94 and G.S. 150B.

History Note: Authority G.S. 110-91;

Eff. July 1, 1991;

Amended Eff. January 1, 2006;

Readopted Eff. July 1, 2023.

15A NCAC 18A .2836 MILDLY SICK CHILDREN

Child care centers that are licensed by the licensing agency to offer care to mildly sick children pursuant to 10A NCAC

09 .2404 shall comply with all rules in this Section except as follows:

(1) Prior to operating a program for mildly sick children, the child care center operator shall undergo a

sanitation inspection of the child care center by the Department.

(2) Drinking fountains shall not be used by mildly sick children.

(3) Toilet fixtures, potty chairs, utility sinks, tubs, and showers shall be cleaned and disinfected after

each use.

(4) Lavatories shall be of a hands-free design or equipped with single-lever faucets.

(5) Cloth diapers shall not be used.

(6) Individually labeled moist towelette containers shall be provided for each child in diapers.

(7) Caregivers shall wear clean disposable gloves when changing each diaper.

(8) Moist towelettes shall not be used in lieu of handwashing for children who cannot support their

heads.

(9) A 36-inch separation shall be maintained or partitions shall be placed between beds, cots and mats

to minimize contact among children.

(10) Furniture shall be nonabsorbent.

(11) Thermometers and mouthable toys shall be cleaned and sanitized between uses by different children.

Soft, cloth material toys may be brought from home if labeled with the name of the child to whom

the toy belongs and used only by that child. If soft toys are provided by the child care center, they

shall be sanitized between uses by different children.

(12) Employees caring for mildly sick children shall not prepare food in a kitchen used to prepare food

for one or more children who are not mildly sick or serve food to children who are not mildly sick.

(13) Family style and other self-serve food service is prohibited.

(14) Carpeted floors are prohibited. Throw rugs may be used if laundered when contaminated and at least

weekly. Floors contaminated by body fluids shall be cleaned and disinfected immediately.

(15) Caregivers shall wash hands in accordance with the procedures in Rule .2803(c) before leaving the

area designated for mildly sick children.

(16) All waste shall be disposed of in a plastic-lined, covered receptacle.

History Note: Authority G.S. 110-91;

Eff. January 1, 2006;

Readopted Eff. July 1, 2023.