DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

LICENSE EXEMPT PROGRAM INSPECTION REPORT
Facility Information

CAMPBELL UNITED METHODIST CHURCH

001465703

(417) 881-5762

1747 E REPUBLIC RD
SPRINGFIELD
MO  65804

CAMPBELL UNITED METHODIST CHURCH



 

KERNS, SHIRLEY

SKERNS@CAMPBELLUMC.ORG


PENNY KREITZER

6 Weeks - 11 Years

150

LICENSE EXEMPT PROGRAM

 
Inspection Information

07/06/2015

10:00 AM

1:01 PM

ANNOUNCED

ANNUAL

2257319369


DocumentDocument-Date
NOTICE OF PARENTAL RESPONSIBILITY 08/15/2014
FIRE/SAFETY INSPECTION 04/29/2015
SANITATION INSPECTION 05/01/2015




Inspection determined facility to be in compliance with rules.
Open Violations: 2
Attendance at Time of Inspection
Total Staff 16
Total Children 59
StaffChildClass AgeNote
2 6 INFANTS AND TODDLERS
2 5 INFANTS AND TODDLERS One and two year old children. Room 122.
2 5 INFANTS AND TODDLERS One and two year old children.
2 10 PRESCHOOL Room 119. Three and four year old children.
2 10 PRESCHOOL Three and four year old children. Room 118.
2 7 PRESCHOOL Four and five year old children.
2 7 PRESCHOOL Four and five year old children. Room 213.
0 0 PRESCHOOL Room 114 Twos and threes. Children were not in the classroom at the time of inspection.
0 0 PRESCHOOL Room 115. No children present in the room at the time of inspection.
0 0 PRESCHOOL Room 116. No children present in the room at the time of inspection.
2 9 PRESCHOOL Two and three year old children. Room 117.

 
19 CSR 30-60.020 Application for Annual Fire Safety and Health and Sanitation Inspections and Inspection Procedures
Compliance
19 CSR 30-60.050 Staffing Requirements
Compliance
19 CSR 30-60.060 Health Requirements
Violation
 Provider Comments
Violation
Medical examination reports including TB testing were not on file for caregivers as evidenced by the medical form did not contain all required information in that the results of the TB testing were not listed.
Licensing Rule Reference
19 CSR 30-60.060 Health Requirements 1 (D) 2 states: The facility may use the department's physical assessment form, MO 580-1879 (6- 94), or the facility may use its own form if it contains all the information on the department's form.
Correction Required
Medical/TB reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-60.070 Responsibilities of Caregivers
Compliance
19 CSR 30-60.080 Fire Safety Requirements
Compliance
19 CSR 30-60.090 Sanitation Requirements
Compliance
19 CSR 30-60.100 Physical Plant, Space, Supplies and Equipment
Violation
 Provider Comments
Violation
Hazardous items as follows were accessible to children: shaving cream, white out and hand sanitizer, diaper cream. The item(s) was/were located within reach of children in room 114.
Licensing Rule Reference
19 CSR 30-60.100 Physical Plant, Space, Supplies and Equipment 1 (D) states: Hazardous materials such as cleaning supplies, poisonous materials, medicines, alcoholic beverages or hazardous personal care items shall be inaccessible to children and stored to prevent cross-contamination of food and food-related materials.
Correction Required
Hazardous material(s) shall be inaccessible to children and stored to prevent cross-contamination of food and food-related items.

Correction Verification
Corrected on Site

Compliance Date
7/6/2015
Violation
The premises were not safe and suitable as evidenced by an infant was propped while sleeping.
Licensing Rule Reference
19 CSR 30-60.100 Physical Plant, Space, Supplies and Equipment 1 states: The premises of all facilities shall be safe and suitable for the care of children.
Correction Required
The premises shall be safe and suitable for the care of children.

Correction Verification
Corrected on Site

Compliance Date
7/6/2015
Violation
Hazardous items as follows were accessible to children: white out and a battery. The item(s) was/were located within reach of children in room 115.
Licensing Rule Reference
19 CSR 30-60.100 Physical Plant, Space, Supplies and Equipment 1 (D) states: Hazardous materials such as cleaning supplies, poisonous materials, medicines, alcoholic beverages or hazardous personal care items shall be inaccessible to children and stored to prevent cross-contamination of food and food-related materials.
Correction Required
Hazardous material(s) shall be inaccessible to children and stored to prevent cross-contamination of food and food-related items.

Correction Verification
Corrected on Site

Compliance Date
7/6/2015
Violation
Hazardous items as follows were accessible to children: shaving cream and petroleum jelly. The item(s) was/were located within reach of children in room 116.
Licensing Rule Reference
19 CSR 30-60.100 Physical Plant, Space, Supplies and Equipment 1 (D) states: Hazardous materials such as cleaning supplies, poisonous materials, medicines, alcoholic beverages or hazardous personal care items shall be inaccessible to children and stored to prevent cross-contamination of food and food-related materials.
Correction Required
Hazardous material(s) shall be inaccessible to children and stored to prevent cross-contamination of food and food-related items.

Correction Verification
Corrected on Site

Compliance Date
7/6/2015
Violation
Hazardous items as follows were accessible to children: hand sanitizer, big scissors, shaving cream, Febreeze, hair detangler, alcohol. The item(s) was/were located within reach of children in room 119.
Licensing Rule Reference
19 CSR 30-60.100 Physical Plant, Space, Supplies and Equipment 1 (D) states: Hazardous materials such as cleaning supplies, poisonous materials, medicines, alcoholic beverages or hazardous personal care items shall be inaccessible to children and stored to prevent cross-contamination of food and food-related materials.
Correction Required
Hazardous material(s) shall be inaccessible to children and stored to prevent cross-contamination of food and food-related items.

Correction Verification
Corrected on Site

Compliance Date
7/6/2015
Violation
Hazardous items as follows were accessible to children: sunscreen and shaving cream. The item(s) was/were located within reach of children in room 118.
Licensing Rule Reference
19 CSR 30-60.100 Physical Plant, Space, Supplies and Equipment 1 (D) states: Hazardous materials such as cleaning supplies, poisonous materials, medicines, alcoholic beverages or hazardous personal care items shall be inaccessible to children and stored to prevent cross-contamination of food and food-related materials.
Correction Required
Hazardous material(s) shall be inaccessible to children and stored to prevent cross-contamination of food and food-related items.

Correction Verification
Corrected on Site

Compliance Date
7/6/2015
Violation
Hazardous items as follows were accessible to children: batteries, scissors, white out, shaving cream, hand sanitizer and sunscreen. The item(s) was/were located within reach of children in the four and five year old room.
Licensing Rule Reference
19 CSR 30-60.100 Physical Plant, Space, Supplies and Equipment 1 (D) states: Hazardous materials such as cleaning supplies, poisonous materials, medicines, alcoholic beverages or hazardous personal care items shall be inaccessible to children and stored to prevent cross-contamination of food and food-related materials.
Correction Required
Hazardous material(s) shall be inaccessible to children and stored to prevent cross-contamination of food and food-related items.

Correction Verification
Corrected on Site

Compliance Date
7/6/2015
Violation
Hazardous items as follows were accessible to children: white out, batteries, medicated ointment, scissors. The item(s) was/were located within reach of children in room 213.
Licensing Rule Reference
19 CSR 30-60.100 Physical Plant, Space, Supplies and Equipment 1 (D) states: Hazardous materials such as cleaning supplies, poisonous materials, medicines, alcoholic beverages or hazardous personal care items shall be inaccessible to children and stored to prevent cross-contamination of food and food-related materials.
Correction Required
Hazardous material(s) shall be inaccessible to children and stored to prevent cross-contamination of food and food-related items.

Correction Verification
Corrected on Site

Compliance Date
7/6/2015
Violation
The premises were not safe and suitable as evidenced by one crib did not have documentation to show that it meets safety standards.
Licensing Rule Reference
19 CSR 30-60.100 Physical Plant, Space, Supplies and Equipment 1 states: The premises of all facilities shall be safe and suitable for the care of children.
Correction Required
The premises shall be safe and suitable for the care of children.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-60.110 Transportation and Field Trip Requirements
Compliance
19 CSR 30-60.120 Admission Procedures and Required Reports and Records
Compliance
RSMo 210.254 Religious organization operating facilities exempt under licensing laws required to file parental notice of responsibility and fire, safety inspections annually.
Compliance
RSMo 210.255 Religious organizations operating facility in violation, procedure - noncompliance after notice, prosecutor may act or attorney general.
Compliance
RSMo 252 Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized.
Compliance