DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT
Facility Information

CANCIENNE, SHANNON

002020959

(636) 464-2691

5512 LEHIGH LN
IMPERIAL
MO  63052-1718

CANCIENNE, SHANNON MARIA



 

CANCIENNE, SHANNON MARIA

shancan7@gmail.com


AMBER JENNINGS

6 WEEKS - 12 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

11/17/2017

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2318279110


DocumentDocument-Date
SAMPLE WEEKLY MENU 03/04/2009
SAMPLE FORMS 03/04/2009
POLICIES 03/04/2009
OWNER/PROVIDER REFERENCES 03/04/2009
LOCAL FIRE DEPARTMENT NOTIFICATION 03/04/2009
DIAGRAM/OUTDOOR 03/04/2009
DIAGRAM/INDOOR 03/04/2009
DAILY SCHEDULE 03/04/2009
CHILD CARE/DISCIPLINE POLICIES 03/04/2009
APPLICATION 12/08/2016
EQUIPMENT LIST 12/08/2016
ASSISTANT REFERENCES 03/24/2015
ASSISTANT APPROVAL REQUEST 03/24/2015
FIRE/SAFETY INSPECTION 12/05/2016
SANITATION INSPECTION 11/15/2016

Overlap Start TimeOverlap End TimeOverlap Submit Date
  3:45PM   5:45PM   12/14/2010



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
Compliance
19 CSR 30-61.090 Disaster and Emergency Preparedness
Violation
 Provider Comments
Violation
The facility's special instructions for infants and non-ambulatory children were not posted in each room used for child care.
Licensing Rule Reference
19 CSR 30-61.090 Disaster and Emergency Preparedness 2 (B) 3 states: Any special instructions for infants and non-ambulatory children.
Correction Required
Facility must post information as required.

Correction Verification
Submit Documentation

Compliance Date
9/6/2017
Violation
The facility's disaster and emergency plan was not available in each room used for child care as evidenced by there was no Emergency Plan available onsite.
Licensing Rule Reference
19 CSR 30-61.090 Disaster and Emergency Preparedness 2 (A) states: At all times, a copy of the facility's disaster emergency plan is readily available in the office area and in each room used for care of children.
Correction Required
The facilities disaster and emergency plan must be available in required locations.

Correction Verification
Submit Documentation

Compliance Date
9/6/2017
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
The provider was not present 40 hours a week during the hours of highest attendance as evidenced by there were no provider attendance records available to verify that the provider is onsite 40 hrs per week.
Licensing Rule Reference
19 CSR 30-61.105 The Day Care Provider and Other Day Care Personnel 1 (A) states: The provider routinely shall be present during the hours of highest attendance a minimum of forty (40) hours per week.
Correction Required
The provider shall be routinely on duty as required.

Correction Verification
Submit Documentation

Compliance Date
11/16/2017
Violation
The provider did not meet requirements for requests/results of background reviews. Reviews were missing/out of date for the following provider/employee/adult household member: Shannon Cancienne, Liz Stevens and all family members had no accessible background screenings onsite.
Licensing Rule Reference
19 CSR 30-61.105 The Day Care Provider and Other Day Care Personnel 1 (K) states: The provider, other household members, and other child care personnel shall be screened for child abuse/neglect. Any investigated allegation of child abuse or neglect involving these persons in which the investigator finds reasonable cause to believe that this person is the alleged perpetrator of child abuse or neglect shall be evaluated by the department. After review, the department may prohibit this person from being present in the home during child care hours.
Correction Required
Required requests/results of current background checks shall be on file.

Correction Verification
Submit Documentation

Compliance Date
11/17/2017
Violation
The provider did not meet requirements for requests/results of background reviews. Reviews were missing/out of date for the following provider/employee/adult household member: Shannon Cancienne, Liz Stevens and all household members had no criminal records review available onsite.
Licensing Rule Reference
19 CSR 30-61.105 The Day Care Provider and Other Day Care Personnel 1 (L) states: The child care provider shall request and have on file the results of a criminal record review from the Missouri State Highway Patrol as defined by 19 CSR 30-61.045 Initial Licensing Information and 19 CSR 30-61.055 License Renewal. This shall include the results of a criminal record review from the Missouri State Highway Patrol for the child care provider, all persons employed by the child care provider, and all adult household members. The child care provider shall request a criminal record review within ten (10) days following the employment of any person and within ten (10) days after any adult becomes a household member. The department may request a criminal record review for any adult present in the family day care home when child care children are present. The criminal record reviews shall include records of criminal convictions, pending criminal charges, and suspended imposition of sentence during the term of probation. Requests for criminal record reviews shall be made on a form provided by the highway patrol.
Correction Required
Required requests/results of current background checks shall be on file.

Correction Verification
Submit Documentation

Compliance Date
11/17/2017
Violation
Verification of safe sleep training was not documented and maintained as evidenced by There were no provider or staff files accessible onsite and safe sleep training could not be verified.
Licensing Rule Reference
19 CSR 30-61.105 The Day Care Provider and Other Day Care Personnel 5 (A) states: The training shall be documented and maintained as described in subsection (4)(B) of this rule.
Correction Required
Safe sleep training shall be documented and maintained.

Correction Verification
Submit Documentation

Compliance Date
11/16/2017
Violation
The requirements for first aid and CPR training were not met as evidenced by there was no documentation on file showing completion of first aid certification.
Licensing Rule Reference
19 CSR 30-61.105 The Day Care Provider and Other Day Care Personnel 1 (N) states: The provider shall have documentation on file at the home of current certification in age-appropriate first aid and cardiopulmonary resuscitation (CPR) training. The training shall be certified by a nationally-recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification approved by the department. At least one (1) caregiver with current certification in age-appropriate first aid and CPR must be on site at all times when children are present. First aid/CPR training may count toward the annual clock hour training requirement.
Correction Required
Required certification in first aid/CPR shall be on file. At least one caregiver with the certification shall be on site as required.

Correction Verification
Submit Documentation

Compliance Date
9/6/2017
Violation
The requirements for first aid and CPR training were not met as evidenced by there was no documentation on file showing completion of CPR certification.
Licensing Rule Reference
19 CSR 30-61.105 The Day Care Provider and Other Day Care Personnel 1 (N) states: The provider shall have documentation on file at the home of current certification in age-appropriate first aid and cardiopulmonary resuscitation (CPR) training. The training shall be certified by a nationally-recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification approved by the department. At least one (1) caregiver with current certification in age-appropriate first aid and CPR must be on site at all times when children are present. First aid/CPR training may count toward the annual clock hour training requirement.
Correction Required
Required certification in first aid/CPR shall be on file. At least one caregiver with the certification shall be on site as required.

Correction Verification
Submit Documentation

Compliance Date
9/6/2017
19 CSR 30-61.115 Day Care Family and Household
Compliance
19 CSR 30-61.125 Medical Examination Reports
Violation
 Provider Comments
Violation
A medical examination report was not on file for the provider.
Licensing Rule Reference
19 CSR 30-61.125 Medical Examination Reports 1 (B) states: The provider shall have a medical examination report on file at the time of initial licensure.
Correction Required
Medical reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date
11/16/2017
Violation
A medical examination report was not on file for the assistant and/or volunteer.
Licensing Rule Reference
19 CSR 30-61.125 Medical Examination Reports 1 (D) states: Assistants who are employed or volunteer more than five (5) hours per week shall have a medical examination report on file within thirty (30) days of beginning work in the home.
Correction Required
Medical reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date
11/16/2017
Violation
Medical examination report did not include a completed Risk Assessment for Tuberculosis form.
Licensing Rule Reference
19 CSR 30-61.125 Medical Examination Reports 1 (E) . states: Medical examination reports shall include a “Risk Assessment for Tuberculosis” form, included herein, completed and signed by a health care professional, as provided by the Missouri Department of Health and Senior Services (MDHSS). If the person has signs or symptoms of tuberculosis, or risk factors for tuberculosis, then testing for tuberculosis shall occur.
Correction Required
TB reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date
11/16/2017
Violation
Requirements for infant-toddler/preschool child medical examination reports on file were not met as evidenced by there was no medical examination report on file within 30 days of admission - the admission date(s) was/were Unknown-no file onsite.
Licensing Rule Reference
19 CSR 30-61.125 Medical Examination Reports 2 (A) states: The provider shall require, within thirty (30) days following the admission of each infant, toddler or preschool child, a medical examination report signed by a licensed physician or registered nurse who is under the supervision of licensed physician and completed not more than twelve (12) months prior to admission.
Correction Required
Child medical requirements shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
11/16/2017
19 CSR 30-61.135 Admission Policies and Procedures
Violation
 Provider Comments
Violation
An individualized plan for specialized care for a child with special physical, developmental or behavioral needs were not met as evidenced by there was no plan on file for a child with special needs.
Licensing Rule Reference
19 CSR 30-61.135 Admission Policies and Procedures 4 states: A child who has a special physical, developmental or behavioral need shall have on file an individualized plan for specialized care from a professionally qualified source.
Correction Required
An individualized plan from a professional source shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date
9/6/2017
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
9/6/2017
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
The requirements for administering medication were not met as follows: medication was given to a child without written permission.
Licensing Rule Reference
19 CSR 30-61.185 Health Care 3 (B) states: All medication shall be given to a child only with the dated, written permission of the parent(s) stating the length of time the medication may be given.
Correction Required
All medication shall be administered and recorded as required.

Correction Verification
Submit Documentation

Compliance Date
9/6/2017
Violation
Requirements for immunization reports on file were not met as evidenced by required immunizations verifying the type of vaccine and the month, day and year of administration was not on file for 2 child(ren).
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
9/6/2017
19 CSR 30-61.190 Nutrition and Food Service
Violation
 Provider Comments
Violation
Requirements for food sanitation were not maintained as evidenced by the tables were not washed or sanitized prior to snack being served.
Licensing Rule Reference
19 CSR 30-61.190 Nutrition and Food Service 1 (I) states: State or local rules, or both, governing food service sanitation shall be maintained in the storage, preparation and service of foods.
Correction Required
The facility shall follow state and local rules regarding food service sanitation.

Correction Verification
Submit Documentation

Compliance Date
9/6/2017
19 CSR 30-61.200 Transportation and Field Trips
Compliance
19 CSR 30-61.210 Records and Reports
Violation
 Provider Comments
Violation
1 child(ren) records did not include field trip and transportation authorization.
Licensing Rule Reference
19 CSR 30-61.210 Records and Reports 2 (F) states: Field trip and transportation authorization.
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
9/6/2017
Violation
2 child(ren) records did not include name, address and telephone number of another individual who might be reached in an emergency.
Licensing Rule Reference
19 CSR 30-61.210 Records and Reports 2 (C) states: Name, address and telephone number of another individual (friend or relative) who might be reached in an emergency when the parent(s), guardian or legal custodian cannot be reached.
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
9/6/2017
Violation
1 child(ren) records did not include full name, home address, employers name and address, work schedule and home and work telephone numbers of the parent(s), guardian or legal custodian.
Licensing Rule Reference
19 CSR 30-61.210 Records and Reports 2 (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers’ name and address, work schedule and home and work telephone numbers.
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
9/6/2017
Violation
Daily attendance records were not maintained on file as required as evidenced by there was no caregiver/volunteer attendance record.
Licensing Rule Reference
19 CSR 30-61.210 Records and Reports 7 states: Daily attendance records for all caregivers shall be maintained and kept on file a minimum of one (1) year.
Correction Required
Child and caregiver/volunteer attendance records shall be maintained/retained as required.

Correction Verification
Submit Documentation

Compliance Date
9/6/2017
Violation
Daily attendance records were not maintained on file as required as evidenced by there was no child attendance record.
Licensing Rule Reference
19 CSR 30-61.210 Records and Reports 6 states: Daily child attendance records shall be maintained and kept on file a minimum of one (1) year.
Correction Required
Child and caregiver/volunteer attendance records shall be maintained/retained as required.

Correction Verification
Submit Documentation

Compliance Date
9/6/2017
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