MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
BLOOMFIELD, ANNETTE PAMELA

Facility DVN
000786734

Phone
(573) 445-3369

Physical Address
1302 JAKE LN
COLUMBIA
MO 65203-0816

Owner
BLOOMFIELD, ANNETTE PAMELA

Mailing Address

Provider/Director

E-mail Address
APBISME@GMAIL.COM

Incorporated

Child Care Specialist
JIM PARSLEY

Age Range
12 MONTHS - 12 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
02/01/2017

Arrival Time
9:30 AM

Departure Time
10:46 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2298514227

Document	Document-Date
SAMPLE WEEKLY MENU	10/19/2006
EQUIPMENT LIST	08/18/2016
APPLICATION	06/13/2016
FIRE/SAFETY INSPECTION	06/16/2016
SANITATION INSPECTION	07/13/2016
CHILD CARE/DISCIPLINE POLICIES	10/19/2006
OWNER/PROVIDER REFERENCES	06/14/2006
ASSISTANT REFERENCES	07/18/2013
SAMPLE FORMS	07/14/2006
DAILY SCHEDULE	07/14/2006
POLICIES	10/19/2006
DIAGRAM/OUTDOOR	07/14/2006
DIAGRAM/INDOOR	07/14/2006
ASSISTANT APPROVAL REQUEST	07/25/2014

Overlap Start Time	Overlap End Time	Overlap Submit Date
10:00AM	12:00PM	2/18/2014

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.

Attendance at Time of Inspection

Total Staff 3

Total Children 10

Staff	Child	Class Age	Note
3	10	PRESCHOOL	There were 10 preschool children, including 2 two-year-olds, being supervised by: (1) Annette Bloomfield (2) Matt Bloomfield (3) Hannah Dougherty