MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
ROTH, MARTINA H

Facility DVN
002289125

Phone
(816) 431-4903

Physical Address
1721 TODD ST
PLATTE CITY
MO 64079-9356

Owner
ROTH, MARTINA H

Mailing Address

Provider/Director

E-mail Address
GPTINA36@GMAIL.COM

Incorporated

Child Care Specialist
JANA BARTON

Age Range
6 WEEKS - 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 6 CHILDREN IN CARE NO MORE THAN 3 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER

Inspection Information

Date
05/29/2018

Arrival Time
11:50 AM

Departure Time
12:55 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2331090179

Document	Document-Date
FIRE/SAFETY INSPECTION	05/01/2018
ASSISTANT REFERENCES	07/22/2011
SAFE SLEEP POLICY	05/11/2016
SANITATION INSPECTION	03/19/2018
DISASTER AND EMERGENCY PREPAREDNESS PLAN	06/01/2018
DAILY SCHEDULE	06/17/2011
CHILD CARE/DISCIPLINE POLICIES	06/17/2011
POLICIES	06/17/2011
SAMPLE FORMS	06/17/2011
OWNER/PROVIDER REFERENCES	06/17/2011
ASSISTANT APPROVAL REQUEST	06/14/2013
DIAGRAM/INDOOR	07/19/2011
DIAGRAM/OUTDOOR	07/19/2011
APPLICATION	04/10/2017
EQUIPMENT LIST	04/10/2017
SAMPLE WEEKLY MENU	06/17/2011

Overlap Start Time	Overlap End Time	Overlap Submit Date
12:15PM	2:15PM	5/29/2018

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 1

Total Children 7

Staff	Child	Class Age	Note
1	7	MIXED	Two are under age 2


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 Not Observed
19 CSR 30-61.165 Emergency School Closings Not Observed
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