DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

INDEPENDENCE SCHOOL DISTRICT

002318825

(816) 521-5438

1525 N NOLAND RD
INDEPENDENCE
MO  64050

INDEPENDENCE SCHOOL DISTRICT

201 N FOREST AVE
INDEPENDENCE
MO  64050

VAN RADEN, SHAWN LEE

SANDRA_DEMPSEY@ISDSCHOOLS.ORG


ROMENA FOX

5 YEARS - 11 YEARS

60

SCHOOL AGE

BEFORE AND AFTER SCHOOL CARE ONLY
 
Inspection Information

12/03/2018

3:30 PM

5:29 PM

UNANNOUNCED

COMPLIANCE MONITORING

2345521677


DocumentDocument-Date
SAMPLE FORMS 01/24/2012
LOCAL FIRE DEPARTMENT NOTIFICATION 01/24/2012
JOB RESPONSIBILITIES 01/24/2012
DISCIPLINE POLICIES 01/24/2012
DIRECTOR'S JOB RESPONSIBILITIES 01/24/2012
CHILD CARE PRACTICES 01/24/2012
SAMPLE WEEKLY MENU 01/24/2012
POLICIES 01/24/2012
LINES OF ADMINISTRATIVE AUTHORITY 01/24/2012
DIRECTOR'S QUALIFICATIONS 11/25/2011
DAILY SCHEDULE 01/24/2012
APPLICATION 11/01/2017
STAFF SHEET 12/07/2017
EQUIPMENT LIST 12/07/2017




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 1
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 25
StaffChildClass AgeNote
2 25 SCHOOL AGE

 
19 CSR 30-62.032 Organization and Administration
Not Observed
19 CSR 30-62.042 Initial Licensing Information
Not Observed
19 CSR 30-62.052 License Renewal
Not Observed
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
Violation
 Provider Comments
Violation
Requirements of facilities participation in disaster and emergency drills were not met as evidenced by the disaster or emergency drill was not held at least one time every three months.
Licensing Rule Reference
19 CSR 30-62.090 Disaster and Emergency Preparedness (3) (A) states: The licensee shall ensure that the facility has on file documentation that, at least every three (3) months, all staff and children at the facility have participated in a disaster or emergency drill based on the facility's disaster and emergency plan.
Correction Required
Fire, tornado, and other disaster drills shall be completed and recorded as required.

Correction Verification
Submit Documentation

Compliance Date
5/18/2018
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
Violation
 Provider Comments
Violation
Medical examination report was not on file for Chloe Huston and Hana Holder as evidenced by a medical examination was not on file within 30 days of an individual beginning to work with children.
Licensing Rule Reference
19 CSR 30-62.122 Medical Examination Reports (1) (A) states: All persons working in a day care facility in any capacity during child care hours, including volunteers counted in staff/child ratios, shall be in good physical and emotional health with no physical or mental conditions which would interfere with child care responsibilities. These persons shall have a medical examination report, signed by a licensed physician or registered nurse who is under the supervision of a licensed physician, on file at the facility at the time of initial licensure or within thirty (30) days following employment.
Correction Required
Medical reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date
12/3/2018
Violation
Medical examination report did not include a completed Risk Assessment for Tuberculosis form for Chloe Huston and Hana Holder.
Licensing Rule Reference
19 CSR 30-62.122 Medical Examination Reports (1) (B) states: Medical examination reports shall include a “Risk Assessment for Tuberculosis” form, included herein, completed and signed by a health care professional, as provided by the Missouri Department of Health and Senior Services (MDHSS). If the person has signs or symptoms of tuberculosis, or risk factors for tuberculosis, then testing for tuberculosis shall occur.
Correction Required
TB reports shall be on file as required

Correction Verification
Submit Documentation

Compliance Date
12/3/2018
Violation
A school-age child's health report was not on file at the time of enrollment as evidenced by two (2) children's health reports do not show whether there are any health problems or concerns on May 17, 2018 (corrected 12/3/18). On December 3, 2018, three (3) children's health reports did not show whether there were any health problems or concerns (corrected on site).
Licensing Rule Reference
19 CSR 30-62.122 Medical Examination Reports (2) (D) states: The parent(s) of a school-age child shall provide a report at the time of enrollment indicating the child's health history, any current health problems, and any restrictions necessary for the child's care.
Correction Required
Child medical requirements shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
12/3/2018
19 CSR 30-62.132 Admission Policies and Procedures
Violation
 Provider Comments
Violation
Written permission was not on file for field trips.
Licensing Rule Reference
19 CSR 30-62.132 Admission Policies and Procedures (8) (E) 6. states: Permission for field trips, transportation to and from school and other transportation;
Correction Required
Written permission for field and transportation shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date
12/3/2018
Violation
An individualized plan for specialized care for a child with special physical, developmental or behavioral needs was not on file.
Licensing Rule Reference
19 CSR 30-62.132 Admission Policies and Procedures (6) states: A child who has a special physical, developmental or behavioral need shall have on file an individualized plan for specialized care from a professionally qualified source.
Correction Required
An individualized plan from a professional source shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-62.172 Emergency School Closings
Not Observed
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
Not Observed
19 CSR 30-62.212 Transportation and Field Trips
Not Observed
19 CSR 30-62.222 Records and Reports
Violation
 Provider Comments
Violation
The provider failed to maintain accurate records to meet administrative requirements as evidenced by one (1) child's file did not contain the father's information.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (1) states: The child care provider shall maintain accurate records to meet administrative requirements and to ensure knowledge of the individual needs of children and their families.
Correction Required
Accurate records shall be maintained.

Correction Verification
Submit Documentation

Compliance Date
12/3/2018
Violation
One (1) child's record did not include work schedule of parent(s), guardian or legal custodian on May 17, 2018 (corrected 12/3/18). On December 3, 2018, one (1) child(ren) records did not include work schedule of parent(s), guardian or legal custodian.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
12/3/2018
Violation
Six (6) children's records did not include employers' address of parent(s), guardian or legal custodial on May 17, 2018 (corrected 12/3/18). On December 3, 2018, five (5) child(ren) records did not include employers' address of parent(s), guardian or legal custodian.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
12/3/2018
Violation
Six (6) children's records did not include address of another individual who might be reached in an emergency on May 17, 2018 (corrected 12/3/18). On December 3, 2018, five (5) child(ren) records did not include address of another individual who might be reached in an emergency.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (2) (C) states: Name, address and telephone number of another individual (friend or relative) who might be reached in an emergency when the parent(s), guardian or legal custodian cannot be reached;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
12/3/2018
Violation
Two (2) child(ren) records did not include work telephone number of parent(s), guardian or legal custodian.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Corrected on Site

Compliance Date
12/3/2018
RSMo 210.003 Immunizations of children required, when, exceptions--duties of administrator, report--notification of parents, when.
Compliance
RSMo 210.1080 Background checks required--definitions--procedures—ineligible for employment, when--exemption, when--emergency rules.
Not Observed