DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT
Facility Information

POTTER, SHIRLEY

000680937

(573) 474-3750

4808 ANGELO CT
COLUMBIA
MO  65202

POTTER, SHIRLEY J



 


TEPSJPOTTER@YAHOO.COM


CYNTHIA D MADDOX

BIRTH - 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

02/13/2018

9:00 AM

10:56 AM

ANNOUNCED

RENEWAL

2324250446


DocumentDocument-Date
ASSISTANT REFERENCES 12/29/2009
OWNER/PROVIDER REFERENCES 02/04/2004
POLICIES 02/08/1995
ASSISTANT APPROVAL REQUEST 12/29/2009
SAMPLE WEEKLY MENU 04/02/2004
DAILY SCHEDULE 01/13/1995
CHILD CARE/DISCIPLINE POLICIES 02/08/1995
DIAGRAM/OUTDOOR 02/04/2004
DIAGRAM/INDOOR 02/04/2004
SANITATION INSPECTION 02/13/2018
FIRE/SAFETY INSPECTION 11/28/2017
APPLICATION 12/20/2017
EQUIPMENT LIST 02/13/2018




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 7
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 5
StaffChildClass AgeNote
2 5 MIXED Shirley and Terry were the caregivers with the children. Children range in age from 7 months to 5 years with 1 child under age 2 years. No related children in care.

 
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
Violation
 Provider Comments
Violation
The provider did not meet requirements for requests/results of background reviews. Reviews were missing/out of date for the following provider/other personnel/other household members: Shirley Potter, Terry Potter and Mark Potter. .
Licensing Rule Reference
19 CSR 30-61.055 License Renewal 2 states: The child care provider, other personnel and other household members shall be screened for child abuse/neglect prior to renewal of the license.
Correction Required
Required requests/results of current background checks shall be on file.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-61.085 Physical Requirements of the Family Day Care Home
Violation
 Provider Comments
Violation
The facility did not have a fenced outdoor play area that was on or adjoining the day care property and was accessible without hazard as evidenced by the fence had openings that were between 3.5 and 9 inches and allow entrapment - the openings measured approximately 7 inch gap in the back of the fence and a 5 inch gap in the left side of the fence.
Licensing Rule Reference
19 CSR 30-61.085 Physical Requirements of the Family Day Care Home 3 (A) 1 states: An outdoor play area shall be available on or adjoining the day care property. The play area shall be located so it is convenient and the children can gain access to it without hazard. It shall be fenced when necessary for the protection of children from traffic, water or other hazards. For family day care homes initially licensed after the effective date of these rules, or for the installation of new fences in existing facilities, the fence shall be at least forty-two inches (42") high. Fences shall be constructed to prevent children from crawling or falling through or becoming entrapped.
Correction Required
The outdoor play area shall be accessible without hazard and provide a safe fence around the outdoor play area as required.

Correction Verification
Corrected on Site

Compliance Date
2/13/2018
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 first aid and CPR training were not met as evidenced by at least one caregiver certified in first aid/CPR was not on site.
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

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

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

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
Violation
 Provider Comments
Violation
3 child(ren) records did not include employers' address of 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

Violation
4 child(ren) records did not include work schedule of 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

Violation
2 child(ren) records did not include work telephone number of 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

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