MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
FORWARD, PATRICIA

Facility DVN
000479932

Phone
(573) 442-4487

Physical Address
310 E OLD PLANK RD
COLUMBIA
MO 65203

Owner
FORWARD, PATRICIA

Mailing Address

Provider/Director

E-mail Address
PDFORWARD@MSN.COM

Incorporated

Child Care Specialist
JOY LYNN NICHOLS

Age Range
6 WEEKS - 12 YEARS

Capacity
10

Facility Type
FAMILY HOME

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

Inspection Information

Date
08/17/2016

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2286849381

Document	Document-Date
SANITATION INSPECTION	06/09/2016
FIRE/SAFETY INSPECTION	06/02/2016
EQUIPMENT LIST	06/15/2016
APPLICATION	06/15/2016
OWNER/PROVIDER REFERENCES	07/24/1992
POLICIES	06/23/2010
DAILY SCHEDULE	07/28/1996
ASSISTANT REFERENCES	07/30/2010
ASSISTANT APPROVAL REQUEST	07/30/2010
CHILD CARE/DISCIPLINE POLICIES	06/23/2010
SAMPLE WEEKLY MENU	07/24/1992
DIAGRAM/OUTDOOR	07/24/1992
DIAGRAM/INDOOR	04/16/1998

Overlap Start Time	Overlap End Time	Overlap Submit Date
2:45PM	4:45PM	1/11/2016

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.