DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

DOUGLASS COMMUNITY SERVICES, INCORPORATED

000672599

(573) 221-1540

661 CLINIC RD
HANNIBAL
MO  63401-3607

DOUGLASS COMMUNITY SERVICES, INCORPORATED

661 CLINIC RD
HANNIBAL
MO  63401-3607

COMBS, CINDY

EHSCLINIC@DOUGLASSONLINE.ORG

Incorporated

BETHANY C DUCKWORTH

6 WEEKS - 36 MONTHS

16

GROUP HOME AND CENTER

 
Inspection Information

05/18/2020

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2380080818


DocumentDocument-Date
LOCAL ZONING APPROVAL 08/28/2008
DISASTER AND EMERGENCY PREPAREDNESS PLAN 08/06/2019
ARTICLES OF INCORPORATION 06/02/2016
APPLICATION 06/07/2018
EQUIPMENT LIST 06/07/2018
CERTIFICATE OF GOOD STANDING 06/07/2018
STAFF SHEET 08/30/2018
FIRE/SAFETY INSPECTION 06/24/2019
SANITATION INSPECTION 06/03/2019
DIAGRAM/INDOOR 09/10/2002
DIAGRAM/OUTDOOR 09/10/2002
DIRECTOR'S QUALIFICATIONS 01/30/2020
SAFE SLEEP POLICY 12/11/2015
LINES OF ADMINISTRATIVE AUTHORITY 04/27/2009
JOB RESPONSIBILITIES 06/15/2005
CHILD CARE PRACTICES 06/15/2005
POLICIES 06/15/2005
SAMPLE WEEKLY MENU 08/28/2001
SAMPLE FORMS 08/28/2001
DAILY SCHEDULE 08/28/2001
OWNER/PROVIDER REFERENCES 07/05/2001
DISCIPLINE POLICIES 03/03/2010
LLC ARTICLES OF ORGANIZATION 05/24/1993




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.

 
19 CSR 30-62.032 Organization and Administration
Compliance
19 CSR 30-62.042 Initial Licensing Information
Compliance
19 CSR 30-62.052 License Renewal
Compliance
19 CSR 30-62.082 Physical Requirements of Group Day Care Homes and Day Care Centers
Compliance
19 CSR 30-62.087 Fire Safety
Compliance
19 CSR 30-62.090 Disaster and Emergency Preparedness
Compliance
19 CSR 30-62.092 Furniture, Equipment and Materials
Compliance
19 CSR 30-62.102 Personnel
Violation
 Provider Comments
Violation
A facility orientation was not documented and available for review for all caregivers. The following staff need documentation of a facility orientation: Katherine Couch.
Licensing Rule Reference
19 CSR 30-62.102 Personnel (1) (J) . states: The child care provider shall ensure that within seven (7) days of employment or volunteering and before being left alone with children that caregivers receive a facility orientation. The child care provider shall ensure that documentation verifying completion of the facility orientation is maintained and on file for review by the department for each caregiver. The facility orientation shall include:
Correction Required
The facility shall ensure that a facility orientation occurs within 7 days and documentation verifying completion is maintained and on file for review by the department for each caregiver.

Correction Verification
Submit Documentation

Compliance Date
5/15/2020
Violation
The director is not routinely on duty as required, as evidenced by the facility does not have an approved director.
Licensing Rule Reference
19 CSR 30-62.102 Personnel (2) (A) 2. states: Center directors and group day care home providers routinely shall be on duty during the hours of highest attendance a minimum of forty (40) hours per week. If the facility operates less than forty (40) hours per week, the center director or group day care home provider shall be on duty at least fifty percent (50%) of the operating hours.
Correction Required
The director/group day care home provider shall be routinely on duty as required.

Correction Verification
Submit Documentation

Compliance Date
4/29/2020
19 CSR 30-62.112 Staff/Child Ratios
Compliance
19 CSR 30-62.122 Medical Examination Reports
Violation
 Provider Comments
Violation
Medical examination report(s) was/were not on file for Katherine Couch 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
5/15/2020
Violation
A medical examination report did not include a completed Risk Assessment for Tuberculosis form for Katherine Couch.
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
5/15/2020
19 CSR 30-62.132 Admission Policies and Procedures
Compliance
19 CSR 30-62.142 Nighttime Care
Compliance
19 CSR 30-62.152 Hourly Care Facilities
Compliance
19 CSR 30-62.162 Overlap Care of Children
Compliance
19 CSR 30-62.172 Emergency School Closings
Compliance
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
Compliance
19 CSR 30-62.212 Transportation and Field Trips
Compliance
19 CSR 30-62.222 Records and Reports
Compliance
19 CSR 30-63.040 Background Screening Findings
Compliance
RSMo 210.115. Reports of abuse, neglect, and under age eighteen deaths — persons required to report — supervisors and administrators not to impede reporting — deaths required to be reported to the division or child fatality review panel, when — report made to another state, when. —
Compliance
RSMo 210.211.  License required - exceptions - written notice of licensure status, when.
Compliance