MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
CANCIENNE, SHANNON

Facility DVN
002020959

Phone
(636) 464-2691

Physical Address
5512 LEHIGH LN
IMPERIAL
MO 63052-1718

Owner
CANCIENNE, SHANNON MARIA

Mailing Address

Provider/Director
CANCIENNE, SHANNON MARIA

E-mail Address
shancan7@gmail.com

Incorporated

Child Care Specialist
AMBER JENNINGS

Age Range
6 WEEKS - 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
01/25/2018

Arrival Time
8:00 AM

Departure Time
9:14 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2322823099

Document	Document-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	01/09/2018
SANITATION INSPECTION	11/15/2016

Overlap Start Time	Overlap End Time	Overlap 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.

Attendance at Time of Inspection

Total Staff 2

Total Children 4

Staff	Child	Class Age	Note
2	4	MIXED	Elizabeth and Shannon with 4 children, 5 months, 1 year, 3 years, and 4 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 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 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 Compliance
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 Compliance
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