MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
MARTIN, KIMBERLY KAY

Facility DVN
000601165

Phone
(573) 779-3502

Physical Address
10350 WEBSTER ROAD
CALEDONIA
MO 63631

Owner
MARTIN, KIMBERLY KAY

Mailing Address

Provider/Director

E-mail Address
billykim1216@hotmail.com

Incorporated

Child Care Specialist
LEATRICE L DIXON

Age Range
6 WEEKS - 12 YEARS

Capacity
10

Facility Type
FAMILY HOME

Limitations
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
12/27/2018

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2347504150

Document	Document-Date
OWNER/PROVIDER REFERENCES	03/04/1994
DAILY SCHEDULE	04/14/1994
SAMPLE WEEKLY MENU	04/14/1994
POLICIES	05/11/1994
CHILD CARE/DISCIPLINE POLICIES	05/11/1994
DIAGRAM/INDOOR	05/11/1994
DIAGRAM/OUTDOOR	05/11/1994
ASSISTANT REFERENCES	01/19/2010
ASSISTANT APPROVAL REQUEST	03/04/2016
EQUIPMENT LIST	03/09/2018
APPLICATION	03/01/2018
SAFE SLEEP POLICY	10/11/2017
FIRE/SAFETY INSPECTION	03/14/2018
SANITATION INSPECTION	04/10/2018

Overlap Start Time	Overlap End Time	Overlap Submit Date
3:15PM	5:15PM	2/11/2014

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.