MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
CULBERTSON, SHERRY A

Facility DVN
000429549

Phone
(573) 222-6268

Physical Address
4063 COUNTY 290 RD
PUXICO
MO 63960

Owner
CULBERTSON, SHERRY A

Mailing Address

Provider/Director

E-mail Address
sculbertson56@yahoo.com

Incorporated

Child Care Specialist
DAYNEEN GLASTETTER

Age Range
6 WEEKS - 12 YEARS

Capacity
10

Facility Type
FAMILY HOME

Limitations
UP TO 10 CHILDREN IN CARE NO MORE THAN 4 CHILDREN UNDER AGE 2 WITH 2 ADULT CAREGIVERS; UP TO 6 CHILDREN IN CARE NO MORE THAN 3 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 10 CHILDREN IN CARE NO MORE THAN 2 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER

Inspection Information

Date
04/28/2015

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2252544209

Document	Document-Date
SAMPLE WEEKLY MENU	01/31/1992
DIAGRAM/OUTDOOR	02/03/1992
DIAGRAM/INDOOR	02/03/1992
DAILY SCHEDULE	01/31/1992
POLICIES	10/14/2004
CHILD CARE/DISCIPLINE POLICIES	01/31/1992
ASSISTANT APPROVAL REQUEST	03/21/2013
OWNER/PROVIDER REFERENCES	04/23/1991
ASSISTANT REFERENCES	03/21/2013
FIRE/SAFETY INSPECTION	02/09/2015
EQUIPMENT LIST	01/23/2015
APPLICATION	01/23/2015
SANITATION INSPECTION	03/30/2015

Overlap Start Time	Overlap End Time	Overlap Submit Date
3:00PM	5:00PM	3/4/2013

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.


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 Violation
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