MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
CULBERTSON, SHERRY A

Facility DVN
000429549

Phone
(573) 222-6268

Physical Address
4063 COUNTY 290 RD
PUXICO
MO 63960

Owner
CULBERTSON, SHERRY A

Mailing Address

Provider/Director

E-mail Address
sculbertson56@yahoo.com

Incorporated

Child Care Specialist
JESSICA GRAHAM

Age Range
12 MONTHS - 12 YEARS

Capacity
10

Facility Type
FAMILY HOME

Limitations
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
03/01/2018

Arrival Time
11:00 AM

Departure Time
11:46 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2325637410

Document	Document-Date
EQUIPMENT LIST	01/26/2017
APPLICATION	01/26/2017
FIRE/SAFETY INSPECTION	03/06/2017
DAILY SCHEDULE	01/31/1992
ASSISTANT REFERENCES	03/31/2017
ASSISTANT APPROVAL REQUEST	03/31/2017
OWNER/PROVIDER REFERENCES	04/15/1991
SANITATION INSPECTION	02/08/2018
CHILD CARE/DISCIPLINE POLICIES	10/14/2004
SAMPLE WEEKLY MENU	01/31/1992
POLICIES	10/14/2004
DIAGRAM/OUTDOOR	04/03/1991
DIAGRAM/INDOOR	04/03/1991

Inspection determined facility to be in compliance with licensing rules.

Open Violations: 4

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 9

Staff	Child	Class Age	Note
1	9	MIXED


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
19 CSR 30-61.086 Fire Safety Violation
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
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