MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

Back

Facility Information

Facility Name
JACKSON, MILDRED

Facility DVN
000645350

Phone
(573) 719-3410

Physical Address
2122 SPRUCE
HANNIBAL
MO 63401

Owner
JACKSON, MILDRED

Mailing Address

Provider/Director

E-mail Address
MISSMILLIE@DOUGLASSONLINE.ORG

Incorporated

Child Care Specialist
BETHANY C DUCKWORTH

Age Range
BIRTH - 13 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
11/06/2019

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2368653943

Document	Document-Date
DIAGRAM/OUTDOOR	07/23/2008
DIAGRAM/INDOOR	03/31/2010
ASSISTANT APPROVAL REQUEST	06/15/2016
REGISTERING FICTITIOUS NAMES	06/15/2016
SAFE SLEEP POLICY	03/01/2016
APPLICATION	08/13/2018
EQUIPMENT LIST	08/13/2018
FIRE/SAFETY INSPECTION	08/22/2019
SANITATION INSPECTION	06/27/2019
POLICIES	09/15/1994
CHILD CARE/DISCIPLINE POLICIES	09/15/1994
SAMPLE WEEKLY MENU	07/29/1994
DAILY SCHEDULE	07/29/1994
OWNER/PROVIDER REFERENCES	09/01/1994

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.