DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT
Facility Information

JOHANNSEN, STEPHANIE

002196467

(573) 351-1189

1001 BURFORD CT
DONIPHAN
MO  63935-1141

JOHANNSEN, STEPHANIE



 


stephaniedawn4@yahoo.com


MELISSA JILL SMITH

BIRTH - 13 YEARS

10

FAMILY HOME

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

06/15/2017

1:30 PM

3:00 PM

ANNOUNCED

RENEWAL

2308181098


DocumentDocument-Date
APPLICATION 04/24/2017
EQUIPMENT LIST 04/24/2017
CHILD CARE/DISCIPLINE POLICIES 08/05/2015
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
SAMPLE WEEKLY MENU 08/10/2015

Overlap Start TimeOverlap End TimeOverlap 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: 6
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 4
Total Children 20
StaffChildClass AgeNote
2 10 MIXED Stephanie Johannsen and Nikki Johannsen was present with 4 related children also.
2 10 MIXED Stephanie Johannsen and Nikki Johannsen were present with 3 under 2 years of age. There were also 4 related children present.

 
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
Violation
 Provider Comments
Violation
The provider had no evidence of compliance with local or state requirements for nonpublic water supply or sewage disposal system.
Licensing Rule Reference
19 CSR 30-61.085 Physical Requirements of the Family Day Care Home 1 (D) states: Water supply and sewage disposal systems shall conform to state or local requirements, or both.
Correction Required
The facility shall comply with sanitation requirements.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility has not met the requirements for fire and safety as evidenced by the inspection was not approved.
Licensing Rule Reference
19 CSR 30-61.085 Physical Requirements of the Family Day Care Home 1 (B) states: The premises shall conform to the fire and safety requirements of the State Fire Marshal or his/her designee.
Correction Required
The facility shall comply with fire and safety requirements.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-61.086 Fire Safety
Compliance
19 CSR 30-61.090 Disaster and Emergency Preparedness
Compliance
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
The requirements for documentation of 12 clock hours of annual training were not met as evidenced by there were insufficient training documents on file. The staff listed needs the following information: Stephanie needs 1/2 hour to complete her 2016 training.
Licensing Rule Reference
19 CSR 30-61.105 The Day Care Provider and Other Day Care Personnel 4 (A) states: The provider shall obtain at least twelve (12) clock hours of child care-related training during each year of employment in training which is approved by the department in health, safety, nutrition, guidance and discipline, appropriate activities and learning experiences for children, positive communication and interaction with parents, planning and setting up an appropriate environment for children, professional and administrative practices, or other child-related areas. Any assistant working more than five (5) hours per week shall meet the same training requirements.
Correction Required
Required training hours shall be documented for each employee.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-61.115 Day Care Family and Household
Compliance
19 CSR 30-61.125 Medical Examination Reports
Violation
 Provider Comments
Violation
A school-age child's health report was not on file at the time of enrollment as evidenced by not viewing 1 child's on file.
Licensing Rule Reference
19 CSR 30-61.125 Medical Examination Reports 2 (D) states: The parent(s) of a school-age child shall provide a report at the time of enrollment indicating the child's health history, any current health problems, and any restrictions necessary for the child's care.
Correction Required
Child medical requirements shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-61.135 Admission Policies and Procedures
Violation
 Provider Comments
Violation
The provider did not have a completed and signed form for related children.
Licensing Rule Reference
19 CSR 30-61.135 Admission Policies and Procedures 7 . states: If care is provided for children related to the provider who do not live in the home, the parent(s) shall complete and sign a form which is supplied by the department. The form shall be on file at the home before related children are accepted for care and shall contain the following identifying information:
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-61.145 Nighttime Care
Compliance
19 CSR 30-61.155 Overlap Care of Children
Not Observed
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
2/23/2017
Violation
Requirements for immunization reports on file were not met as evidenced by 1 child immunization record(s) was/were not on file .
Licensing Rule Reference
19 CSR 30-61.185 Health Care 4 (A) states: No child shall be permitted to enroll in or attend any day care facility caring for ten (10) or more children unless the child has been adequately immunized against vaccine preventable childhood illnesses specified by the department in accordance with recommendations of Immunization Practices Advisory Committee (ACIP). The parent or guardian of the child shall provide satisfactory evidence of the required immunizations. Satisfactory evidence means a statement, certificate or record from a physician or other recognized health facility or personnel, stating that the required immunizations have been given to the child and verifying the type of vaccine and the month, day and year of administration.
Correction Required
Child immunization requirements shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

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