DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT
Facility Information

JANSEN, KIM D

002016400

(573) 897-2813

71 COTE DESSEIN LN
BONNOTS MILL
MO  65016

JANSEN, KIM D



 


kimjansen128@gmail.com


SHELBY N KOETTING

BIRTH - 12 YEARS

10

FAMILY HOME

UP TO 10 CHILDREN IN CARE NO MORE THAN 2 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 6 CHILDREN IN CARE NO MORE THAN 3 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER
 
Inspection Information

05/14/2019

1:00 PM

1:59 PM

UNANNOUNCED

COMPLIANCE MONITORING

2357542200


DocumentDocument-Date
SAMPLE WEEKLY MENU 01/02/2007
ASSISTANT REFERENCES 05/12/2010
POLICIES 01/02/2007
DAILY SCHEDULE 01/02/2007
CHILD CARE/DISCIPLINE POLICIES 01/02/2007
DIAGRAM/OUTDOOR 01/02/2007
DIAGRAM/INDOOR 01/02/2007
ASSISTANT APPROVAL REQUEST 09/14/2012
APPLICATION 08/16/2018
EQUIPMENT LIST 11/05/2018
FIRE/SAFETY INSPECTION 09/05/2018
SANITATION INSPECTION 08/22/2018

Overlap Start TimeOverlap End TimeOverlap Submit Date
  3:45PM   5:30PM   9/14/2010
  7:00AM   7:15AM   9/14/2010



Inspection determined facility to be in compliance with licensing rules.
Open Violations: 3
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 10
StaffChildClass AgeNote
1 10 MIXED Kim Jansen with 10 kids, 2 under 2.

 
19 CSR 30-61.025 Organization and Administration
Compliance
19 CSR 30-61.045 Initial Licensing Information
Compliance
19 CSR 30-61.055 License Renewal
Compliance
19 CSR 30-61.085 Physical Requirements of the Family Day Care Home
Compliance
19 CSR 30-61.086 Fire Safety
Compliance
19 CSR 30-61.090 Disaster and Emergency Preparedness
Compliance
19 CSR 30-61.095 Furniture, Equipment and Materials
Violation
 Provider Comments
Violation
Outdoor equipment, Little Tikes white playhouse with green roof, in the playground was not in good condition as evidenced by cracked roof and cracks in window ledges that could pinch children's fingers.
Licensing Rule Reference
19 CSR 30-61.095 Furniture, Equipment and Materials 3 (A) states: All outdoor equipment shall be constructed safely, in good condition and free of sharp, loose or pointed parts. Only lead-free paint shall be used.
Correction Required
Outdoor equipment shall have no exposed hazards.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-61.105 The Day Care Provider and Other Day Care Personnel
Compliance
19 CSR 30-61.115 Day Care Family and Household
Compliance
19 CSR 30-61.125 Medical Examination Reports
Violation
 Provider Comments
Violation
A medical examination report was not on file for the assistant and/or volunteer.
Licensing Rule Reference
19 CSR 30-61.125 Medical Examination Reports 1 (D) states: Assistants who are employed or volunteer more than five (5) hours per week shall have a medical examination report on file within thirty (30) days of beginning work in the home.
Correction Required
Medical reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
Medical examination report did not include a completed Risk Assessment for Tuberculosis form.
Licensing Rule Reference
19 CSR 30-61.125 Medical Examination Reports 1 (E) . 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

19 CSR 30-61.135 Admission Policies and Procedures
Compliance
19 CSR 30-61.145 Nighttime Care
Compliance
19 CSR 30-61.155 Overlap Care of Children
Compliance
19 CSR 30-61.165 Emergency School Closings
Compliance
19 CSR 30-61.175 Child Care Program
Compliance
19 CSR 30-61.185 Health Care
Compliance
19 CSR 30-61.190 Nutrition and Food Service
Compliance
19 CSR 30-61.200 Transportation and Field Trips
Compliance
19 CSR 30-61.210 Records and Reports
Compliance
19 CSR 30-63.040 Background Screening Findings
Compliance
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.
Compliance
RSMo 210.252 Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized.
Compliance