MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
THOLEN, LISA

Facility DVN
002550798

Phone
(417) 649-1104

Physical Address
606 E BRIARBROOK LN
CARL JUNCTION
MO 64834-9695

Owner
THOLEN, LISA

Mailing Address

Provider/Director

E-mail Address
ltholen@hotmail.com

Incorporated

Child Care Specialist
GINA HOHENSEE

Age Range
BIRTH - 12 YEARS

Capacity
10

Facility Type
FAMILY HOME

Limitations
2 CHILDREN UNDER 24 MONTHS

Inspection Information

Date
08/29/2018

Arrival Time
11:05 AM

Departure Time
12:01 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2338757318

Document	Document-Date
APPLICATION	07/21/2017
EQUIPMENT LIST	07/21/2017
ASSISTANT APPROVAL REQUEST	08/09/2017
FIRE/SAFETY INSPECTION	07/20/2017
SANITATION INSPECTION	07/31/2017
CHILD CARE/DISCIPLINE POLICIES	10/26/2015
SAMPLE WEEKLY MENU	10/06/2015
DIAGRAM/INDOOR	10/06/2015
DIAGRAM/OUTDOOR	10/06/2015
DAILY SCHEDULE	10/06/2015
OWNER/PROVIDER REFERENCES	10/19/2015
LOCAL FIRE DEPARTMENT NOTIFICATION	10/26/2015
ASSISTANT REFERENCES	10/19/2015
POLICIES	10/26/2015

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 4

Staff	Child	Class Age	Note
1	4	MIXED	2 under 2-years old