DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT
Facility Information

BELBEN, ALLISON

002212126

(417) 315-1621

3934 W YOUNG ST
SPRINGFIELD
MO  65803-5404

BELBEN, ALLISON



 


mrsbelben@gmail.com


ANGEL DONSON

6 WEEKS - 5 YEARS

10

FAMILY HOME

2 CHILDREN UNDER 12 MONTHS; 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

02/21/2018

2:00 PM

2:51 PM

UNANNOUNCED

REINSPECTION

2322634742


DocumentDocument-Date
ASSISTANT REFERENCES 06/27/2012
OWNER/PROVIDER REFERENCES 04/05/2012
ASSISTANT APPROVAL REQUEST 06/27/2012
SAMPLE FORMS 11/18/2011
SAMPLE WEEKLY MENU 11/18/2011
DAILY SCHEDULE 11/18/2011
CHILD CARE/DISCIPLINE POLICIES 11/18/2011
DIAGRAM/OUTDOOR 11/18/2011
DIAGRAM/INDOOR 11/18/2011
FIRE/SAFETY INSPECTION 03/01/2016
EQUIPMENT LIST 04/25/2016
APPLICATION 04/25/2016
SANITATION INSPECTION 05/06/2016




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 5
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 1
Total Children 6
StaffChildClass AgeNote
1 6 MIXED One under two years old

 
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
Not Observed
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
Requirements of facility's participation in disaster and emergency drills were not met as evidenced by the disaster or emergency drill was not held at least one time every three months.
Licensing Rule Reference
19 CSR 30-61.090 Disaster and Emergency Preparedness 3 (A) states: The licensee shall ensure that the facility has on file documentation that, at least every three (3) months, all staff and children at the facility have participated in a disaster or emergency drill based on the facility's disaster and emergency plan.
Correction Required
Fire, tornado, or other disaster drills shall be completed and recorded as required.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-61.095 Furniture, Equipment and Materials
Violation
 Provider Comments
Violation
Furniture/equipment, playpen, in the back room was not in good condition as evidenced by a small hole is in the netting.
Licensing Rule Reference
19 CSR 30-61.095 Furniture, Equipment and Materials 1 (A) 1 states: All furniture and equipment shall be constructed safely, in good condition and free of sharp, loose or pointed parts. Only lead free paint shall be used.
Correction Required
The facility shall provide safe and clean furniture/equipment as required.

Correction Verification
Submit Documentation

Compliance Date

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: Allison Belben.
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
Not Observed
19 CSR 30-61.125 Medical Examination Reports
Violation
 Provider Comments
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 January 4, 2018.
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

19 CSR 30-61.135 Admission Policies and Procedures
Not Observed
19 CSR 30-61.145 Nighttime Care
Not Observed
19 CSR 30-61.155 Overlap Care of Children
Not Observed
19 CSR 30-61.165 Emergency School Closings
Not Observed
19 CSR 30-61.175 Child Care Program
Not Observed
19 CSR 30-61.185 Health Care
Violation
 Provider Comments
Violation
There was no evidence that the two child(ren) had begun the immunization process.
Licensing Rule Reference
19 CSR 30-61.185 Health Care 4 (B) 1 states: Satisfactory evidence is produced that the child has begun the process of immunization. The child may continue to attend as long as the immunization process is being accomplished according to the ACIP/Missouri Department of Health recommended schedule.
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
Not Observed
19 CSR 30-61.200 Transportation and Field Trips
Not Observed
19 CSR 30-61.210 Records and Reports
Violation
 Provider Comments
Violation
The provider failed to maintain accurate records to meet administrative requirements as evidenced by no files were available for review.
Licensing Rule Reference
19 CSR 30-61.210 Records and Reports 1 states: The child care provider shall maintain accurate records to meet administrative requirements and to ensure knowledge of the individual needs of children and their families.
Correction Required
Accurate records shall be maintained.

Correction Verification
Submit Documentation

Compliance Date
2/14/2018
RSMo 210.003 Immunizations of children required, when, exceptions--duties of administrator, report--notification of parents, when.
Not Observed
RSMo 210.252 Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized.
Not Observed