MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
KELLY, MARY

Facility DVN
000647947

Phone
(573) 636-6921

Physical Address
1930 GREEN MEADOW DR
JEFFERSON CITY
MO 65101

Owner
KELLY, MARY

Mailing Address

Provider/Director

E-mail Address
MEKELLY@MCHSI.COM

Incorporated

Child Care Specialist
ALISON MICHELE EVANS

Age Range
BIRTH - 6 YEARS

Capacity
10

Facility Type
FAMILY HOME

Limitations

Inspection Information

Date
06/15/2016

Arrival Time
10:00 AM

Departure Time
11:21 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2282692479

Document	Document-Date
SAMPLE WEEKLY MENU	08/23/1994
POLICIES	11/17/2000
DIAGRAM/OUTDOOR	08/23/1994
DIAGRAM/INDOOR	08/23/1994
DAILY SCHEDULE	08/23/1994
CHILD CARE/DISCIPLINE POLICIES	11/17/2000
OWNER/PROVIDER REFERENCES	08/29/1994
FIRE/SAFETY INSPECTION	10/22/2014
ASSISTANT APPROVAL REQUEST	10/02/2012
EQUIPMENT LIST	09/08/2014
APPLICATION	09/08/2014
SANITATION INSPECTION	09/16/2014

Inspection determined facility to be in compliance with licensing rules.

Open Violations: 1

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 8

Staff	Child	Class Age	Note
1	8	PRESCHOOL	No children under two present.