MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
BELBEN, ALLISON

Facility DVN
002212126

Phone
(417) 315-1621

Physical Address
3934 W YOUNG ST
SPRINGFIELD
MO 65803-5404

Owner
BELBEN, ALLISON

Mailing Address

Provider/Director

E-mail Address
mrsbelben@gmail.com

Incorporated

Child Care Specialist
ANGEL DONSON

Age Range
6 WEEKS - 5 YEARS

Capacity
10

Facility Type
FAMILY HOME

Limitations
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

Date
11/29/2018

Arrival Time
10:15 AM

Departure Time
11:22 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2336147685

Document	Document-Date
EQUIPMENT LIST	07/25/2018
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	02/22/2018
APPLICATION	04/25/2018

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 9

Staff	Child	Class Age	Note
1	9	MIXED