MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
GREEN, CHRISTINA MICHELLE

Facility DVN
002397517

Phone
(660) 883-5698

Physical Address
RR 3 BOX 184
MEMPHIS
MO 63555-9358

Owner
GREEN, CHRISTINA MICHELLE

Mailing Address

Provider/Director

E-mail Address

Incorporated

Child Care Specialist
SUSAN MARIE DOUGLAS

Age Range
BIRTH - 12 YEARS

Capacity
10

Facility Type
FAMILY HOME

Limitations
UP TO 10 CHILDREN IN CARE NO MORE THAN 2 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 6 CHILDREN IN CARE NO MORE THAN 3 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER

Inspection Information

Date
02/06/2015

Arrival Time
11:50 AM

Departure Time
12:33 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2246346362

Document	Document-Date
SANITATION INSPECTION	03/12/2014
SAMPLE WEEKLY MENU	05/29/2013
POLICIES	05/29/2013
OWNER/PROVIDER REFERENCES	12/24/2013
FIRE/SAFETY INSPECTION	03/14/2014
EQUIPMENT LIST	05/29/2013
DIAGRAM/OUTDOOR	12/18/2013
DIAGRAM/INDOOR	12/18/2013
DAILY SCHEDULE	05/29/2013
CHILD CARE/DISCIPLINE POLICIES	05/29/2013
ASSISTANT REFERENCES	06/11/2013
ASSISTANT APPROVAL REQUEST	06/14/2013
APPLICATION	12/12/2013

Inspection determined facility to be in compliance with licensing rules.

Open Violations: NA

NOTE

The licensee is responsible for compliance with all licensing rules, including but not limited to the rules listed on this compliance report form.

Attendance at Time of Inspection

Total Staff 1

Total Children 4

Staff	Child	Class Age	Note
1	4	MIXED


19 CSR 30-61.025 Organization and Administration Compliance
19 CSR 30-61.045 Initial Licensing Information Compliance
19 CSR 30-61.055 License Renewal Compliance
19 CSR 30-61.085 Physical Requirements of the Family Day Care Home Compliance
19 CSR 30-61.086 Fire Safety Compliance
19 CSR 30-61.090 Disaster and Emergency Preparedness Compliance
19 CSR 30-61.095 Furniture, Equipment and Materials Compliance
19 CSR 30-61.105 The Day Care Provider and Other Day Care Personnel Compliance
19 CSR 30-61.115 Day Care Family and Household Compliance
19 CSR 30-61.125 Medical Examination Reports Compliance
19 CSR 30-61.135 Admission Policies and Procedures Compliance
19 CSR 30-61.145 Nighttime Care Compliance
19 CSR 30-61.155 Overlap Care of Children Compliance
19 CSR 30-61.165 Emergency School Closings Compliance
19 CSR 30-61.175 Child Care Program Compliance
19 CSR 30-61.185 Health Care Compliance
19 CSR 30-61.190 Nutrition and Food Service Compliance
19 CSR 30-61.200 Transportation and Field Trips Compliance
19 CSR 30-61.210 Records and Reports Compliance
RSMo 210.252 Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized. Compliance