DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT
Facility Information

MICKELSON, KRISTINA LYNN

001838177

(573) 202-9925

11075 WOODALE DR
ROLLA
MO  65401

MICKELSON, KRISTINA LYNN



 


KRISMIKE@CENTURYLINK.NET


KAYLA TODARO

BIRTH - 13 YEARS

10

FAMILY HOME

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

02/14/2017

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2299353682


DocumentDocument-Date
OWNER/PROVIDER REFERENCES 02/23/2004
SAMPLE WEEKLY MENU 05/05/2004
SAMPLE FORMS 02/02/2004
DAILY SCHEDULE 02/02/2004
CHILD CARE/DISCIPLINE POLICIES 02/02/2004
POLICIES 02/02/2004
DIAGRAM/OUTDOOR 07/30/2004
DIAGRAM/INDOOR 07/30/2004
ASSISTANT APPROVAL REQUEST 05/25/2010
FIRE/SAFETY INSPECTION 05/18/2016
APPLICATION 05/31/2016
EQUIPMENT LIST 05/31/2016
SANITATION INSPECTION 06/29/2016




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.

 
19 CSR 30-61.025 Organization and Administration
Compliance
19 CSR 30-61.045 Initial Licensing Information
Compliance
19 CSR 30-61.055 License Renewal
Compliance
19 CSR 30-61.085 Physical Requirements of the Family Day Care Home
Compliance
19 CSR 30-61.086 Fire Safety
Violation
 Provider Comments
Violation
The requirements for protective outlet covers were not met as evidenced by several outlets were missing protective outlet covers.
Licensing Rule Reference
19 CSR 30-61.086 Fire Safety 11 (B) states: Protective covers or inserts for electrical receptacles shall be installed in all areas occupied by children.
Correction Required
The facility shall use protective outlet covers as required.

Correction Verification
Submit Documentation

Compliance Date
2/14/2017
19 CSR 30-61.090 Disaster and Emergency Preparedness
Violation
 Provider Comments
Violation
The facility's name, address and telephone number was not posted in each room used for child care.
Licensing Rule Reference
19 CSR 30-61.090 Disaster and Emergency Preparedness 2 (B) 1 A states: The name, address, and telephone number of the facility.
Correction Required
Facility must post information as required.

Correction Verification
Submit Documentation

Compliance Date
2/14/2017
Violation
The facility's list of emergency numbers were not posted in each room used for child care.
Licensing Rule Reference
19 CSR 30-61.090 Disaster and Emergency Preparedness 2 (B) 1 B states: A list of emergency numbers, including 911, if available, the fire department, police department, ambulance service, poison control center, and local radio station.
Correction Required
Facility must post information as required.

Correction Verification
Submit Documentation

Compliance Date
2/14/2017
Violation
The facility's evacuation route diagram was not posted in each room used for child care.
Licensing Rule Reference
19 CSR 30-61.090 Disaster and Emergency Preparedness 2 (B) 2 states: A diagram of evacuation routes from the room.
Correction Required
Facility must post information as required.

Correction Verification
Submit Documentation

Compliance Date
2/14/2017
19 CSR 30-61.095 Furniture, Equipment and Materials
Compliance
19 CSR 30-61.105 The Day Care Provider and Other Day Care Personnel
Violation
 Provider Comments
Violation
Requirements for safe sleep training were not met as evidence by the assistant did not complete safe sleep training in that there was no safe sleep certificate for Michael Mickelson.
Licensing Rule Reference
19 CSR 30-61.105 The Day Care Provider and Other Day Care Personnel 5 . states: Every three (3) years the provider and assistant(s) in a family child care home licensed to provide care for infants less than one (1) year of age shall successfully complete department-approved training regarding the American Academy of Pediatrics (AAP) safe sleep recommendations contained in the American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome. Technical report – SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment, by Moon RY, which is incorporated by reference in this rule and published in PEDIATRICS Volume 128, No. 5, November 1, 2011, and available from the University of Vermont College of Medicine, Given Building S261, 89 Beaumont Avenue, Burlington, Vermont 05405-0068, telephone number 802-656-2505, fax number 802-656-4844, or at www.pediatrics.aapublications.org/content/128/5/1030.full. This rule does not incorporate any subsequent amendments or additions.
Correction Required
Provider and assistant shall complete department approved safe sleep training as required.

Correction Verification
Submit Documentation

Compliance Date
2/14/2017
19 CSR 30-61.115 Day Care Family and Household
Compliance
19 CSR 30-61.125 Medical Examination Reports
Compliance
19 CSR 30-61.135 Admission Policies and Procedures
Compliance
19 CSR 30-61.145 Nighttime Care
Compliance
19 CSR 30-61.155 Overlap Care of Children
Compliance
19 CSR 30-61.165 Emergency School Closings
Compliance
19 CSR 30-61.175 Child Care Program
Compliance
19 CSR 30-61.185 Health Care
Violation
 Provider Comments
Violation
Facility did not submit the required annual summary report showing immunization status of each child enrolled by January 15.
Licensing Rule Reference
19 CSR 30-61.185 Health Care 4 (D) states: The administrator of each day care facility shall prepare a record of immunization of each child enrolled in or attending the facility. An annual summary report shall be made by January 15 showing the immunization status of each child enrolled, using forms provided by the department. The immunization records shall be available for review by department personnel upon request.
Correction Required
Facility shall submit an annual summary report by January 15 showing the immunization status of each child enrolled.

Correction Verification
Submit Documentation

Compliance Date
2/14/2017
19 CSR 30-61.190 Nutrition and Food Service
Compliance
19 CSR 30-61.200 Transportation and Field Trips
Compliance
19 CSR 30-61.210 Records and Reports
Compliance
RSMo 210.003 Immunizations of children required, when, exceptions--duties of administrator, report--notification of parents, when.
Compliance
RSMo 210.252 Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized.
Compliance