MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
POTTER, SHIRLEY

Facility DVN
000680937

Phone
(573) 474-3750

Physical Address
4808 ANGELO CT
COLUMBIA
MO 65202

Owner
POTTER, SHIRLEY J

Mailing Address

Provider/Director

E-mail Address
TEPSJPOTTER@YAHOO.COM

Incorporated

Child Care Specialist
JOY LYNN NICHOLS

Age Range
BIRTH - 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
09/04/2019

Arrival Time
10:30 AM

Departure Time
11:36 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2363191391

Document	Document-Date
ASSISTANT REFERENCES	12/29/2009
OWNER/PROVIDER REFERENCES	02/04/2004
POLICIES	02/08/1995
ASSISTANT APPROVAL REQUEST	12/29/2009
SAMPLE WEEKLY MENU	04/02/2004
DAILY SCHEDULE	01/13/1995
CHILD CARE/DISCIPLINE POLICIES	02/08/1995
DIAGRAM/OUTDOOR	02/04/2004
DIAGRAM/INDOOR	02/04/2004
APPLICATION	12/20/2017
EQUIPMENT LIST	02/13/2018
SANITATION INSPECTION	01/10/2019
FIRE/SAFETY INSPECTION	12/19/2018

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	1 child under age two; 3 children ages two and three


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 Compliance
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 Compliance
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