MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
INDEPENDENCE SCHOOL DISTRICT

Facility DVN
001814031

Phone
(816) 521-5443

Physical Address
1403 W LINDEN AVE
INDEPENDENCE
MO 64052

Owner
INDEPENDENCE SCHOOL DISTRICT

Mailing Address
201 N FOREST AVE
INDEPENDENCE
MO 64050

Provider/Director
GANNAWAY, TRISA NICOLE

E-mail Address

Incorporated

Child Care Specialist
JONI BEEM

Age Range
5 YEARS - 11 YEARS

Capacity
20

Facility Type
SCHOOL AGE

Limitations

Inspection Information

Date
08/21/2018

Arrival Time
7:45 AM

Departure Time
8:24 AM

Notice
ANNOUNCED

Inspection Type
RENEWAL

Inspection ID
2337906949

Document	Document-Date
STAFF SHEET	08/21/2018
EQUIPMENT LIST	08/21/2018
APPLICATION	05/30/2018
SAMPLE FORMS	09/04/2014
DIRECTOR'S QUALIFICATIONS	09/11/2014
CHILD CARE PRACTICES	03/21/2012
DIRECTOR'S JOB RESPONSIBILITIES	03/21/2012
DAILY SCHEDULE	03/21/2012
DISCIPLINE POLICIES	03/21/2012
JOB RESPONSIBILITIES	03/21/2012
LINES OF ADMINISTRATIVE AUTHORITY	03/21/2012
POLICIES	03/21/2012
SAMPLE WEEKLY MENU	03/21/2012
DISASTER AND EMERGENCY PREPAREDNESS PLAN	03/21/2012

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	SCHOOL AGE


19 CSR 30-62.032 Organization and Administration Compliance
19 CSR 30-62.042 Initial Licensing Information Compliance
19 CSR 30-62.052 License Renewal Compliance
19 CSR 30-62.082 Physical Requirements of Group Day Care Homes and Day Care Centers Compliance
19 CSR 30-62.090 Disaster and Emergency Preparedness Compliance
19 CSR 30-62.092 Furniture, Equipment and Materials Compliance
19 CSR 30-62.102 Personnel Compliance
19 CSR 30-62.112 Staff/Child Ratios Compliance
19 CSR 30-62.122 Medical Examination Reports Compliance
19 CSR 30-62.132 Admission Policies and Procedures Compliance
19 CSR 30-62.172 Emergency School Closings Compliance
19 CSR 30-62.182 Child Care Program Compliance
19 CSR 30-62.192 Health Care Compliance
19 CSR 30-62.202 Nutrition and Food Service Compliance
19 CSR 30-62.212 Transportation and Field Trips Compliance
19 CSR 30-62.222 Records and Reports Compliance
RSMo 210.003 Immunizations of children required, when, exceptions--duties of administrator, report--notification of parents, when. Compliance