MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
JOHANNSEN, STEPHANIE

Facility DVN
002196467

Phone
(573) 351-1189

Physical Address
1001 BURFORD CT
DONIPHAN
MO 63935-1141

Owner
JOHANNSEN, STEPHANIE

Mailing Address

Provider/Director

E-mail Address
stephaniedawn4@yahoo.com

Incorporated

Child Care Specialist
RONDA TUSCHOFF

Age Range
BIRTH - 13 YEARS

Capacity
10

Facility Type
FAMILY HOME

Limitations
IF ONLY 4 CHILDREN PRESENT, ALL CHILDREN MAY BE 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; 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

Inspection Information

Date
12/14/2015

Arrival Time
12:45 PM

Departure Time
1:41 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2269673456

Document	Document-Date
APPLICATION	07/17/2015
CHILD CARE/DISCIPLINE POLICIES	08/05/2015
FIRE/SAFETY INSPECTION	07/22/2015
OWNER/PROVIDER REFERENCES	07/31/2015
POLICIES	08/05/2015
ASSISTANT APPROVAL REQUEST	08/10/2015
ASSISTANT REFERENCES	08/10/2015
DAILY SCHEDULE	08/10/2015
DIAGRAM/INDOOR	08/10/2015
DIAGRAM/OUTDOOR	08/10/2015
EQUIPMENT LIST	08/10/2015
SAMPLE WEEKLY MENU	08/10/2015
SANITATION INSPECTION	08/10/2015

Overlap Start Time	Overlap End Time	Overlap Submit Date
3:30AM	4:30AM	8/24/2015
7:00AM	8:00AM	8/24/2015

Inspection determined facility to be in compliance with licensing rules.

Open Violations: 18

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 2

Total Children 6

Staff	Child	Class Age	Note
2	6	MIXED	Staff: Stephanie Johannsen, Home Provider Nikki Johannsen, Assistant Adult Visitor: Cassidy Johannsen Six unrelated children including 2 under age 2 years. Five children related to the provider including 3 under age 2 years.