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

07/28/2015

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2258628266


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: NA

 
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
7/17/2015
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
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
7/23/2015
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