DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

SUCCESS R-VI SCHOOL DISTRICT

002491469

(417) 967-2597

10341 HIGHWAY 17
SUCCESS
MO  65570-9605

SUCCESS RVI SCHOOL DISTRICT



 

HICKS, CHELLSI RHEA

chicks@success.k12.mo.us


ELAINE S COX

36 MONTHS - 5 YEARS

20

GROUP HOME AND CENTER

 
Inspection Information

07/13/2020

8:59 AM

9:36 AM

ANNOUNCED

SUPPLEMENTAL

2382136422


DocumentDocument-Date
LOCAL FIRE DEPARTMENT NOTIFICATION 05/27/2020
DISASTER AND EMERGENCY PREPAREDNESS PLAN 09/19/2019
DIRECTOR'S QUALIFICATIONS 11/13/2019
FIRE/SAFETY INSPECTION 01/07/2020
LOCAL BUILDING APPROVAL 03/27/2015
LOCAL ZONING APPROVAL 03/27/2015
SANITATION INSPECTION 01/07/2020
CHILD CARE PRACTICES 03/13/2015
DISCIPLINE POLICIES 03/13/2015
POLICIES 03/13/2015
DIAGRAM/INDOOR 03/13/2015
DIAGRAM/OUTDOOR 03/13/2015
DAILY SCHEDULE 03/13/2015
SAMPLE WEEKLY MENU 03/13/2015
OWNER/PROVIDER REFERENCES 03/26/2015
LINES OF ADMINISTRATIVE AUTHORITY 03/20/2015
JOB RESPONSIBILITIES 03/13/2015
APPLICATION 01/02/2019
EQUIPMENT LIST 01/08/2019
STAFF SHEET 01/08/2019




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 1
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 2
Total Children 5
StaffChildClass AgeNote
2 5 PRESCHOOL 3 and 4 year olds Chellsi Hicks, Devyn Holand

 
19 CSR 30-62.032 Organization and Administration
Not Observed
19 CSR 30-62.042 Initial Licensing Information
Not Observed
19 CSR 30-62.052 License Renewal
Not Observed
19 CSR 30-62.082 Physical Requirements of Group Day Care Homes and Day Care Centers
Not Observed
19 CSR 30-62.087 Fire Safety
Not Observed
19 CSR 30-62.090 Disaster and Emergency Preparedness
Not Observed
19 CSR 30-62.092 Furniture, Equipment and Materials
Not Observed
19 CSR 30-62.102 Personnel
Not Observed
19 CSR 30-62.112 Staff/Child Ratios
Not Observed
19 CSR 30-62.122 Medical Examination Reports
Not Observed
19 CSR 30-62.132 Admission Policies and Procedures
Violation
 Provider Comments
Violation
The facility did not meet requirements for child enrollment and health information as evidenced by provider did not have permission to arrange emergency medical care if the parents can not be reached.
Licensing Rule Reference
19 CSR 30-62.132 Admission Policies and Procedures (8) (E) 4. states: Instructions for action to be taken if the parent(s) or physician designated by the parent(s) cannot be reached in an emergency and permission for emergency medical care;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Corrected on Site

Compliance Date
7/13/2020
19 CSR 30-62.142 Nighttime Care
Not Observed
19 CSR 30-62.152 Hourly Care Facilities
Not Observed
19 CSR 30-62.162 Overlap Care of Children
Not Observed
19 CSR 30-62.172 Emergency School Closings
Not Observed
19 CSR 30-62.182 Child Care Program
Not Observed
19 CSR 30-62.192 Health Care
Violation
 Provider Comments
Violation
Requirements for immunization reports on file were not met as evidenced by required immunizations verifying the type of vaccine and the month, day and year of administration was not on file for 1 child(ren).
Licensing Rule Reference
19 CSR 30-62.192 Health Care (4) (A) states: No child shall be permitted to enroll in or attend any day care facility caring for ten (10) or more children unless the child has been immunized adequately against vaccine preventable childhood illnesses specified by the department in accordance with recommendations of the Immunization Practices Advisory Committee (ACIP). The parent or guardian of the child shall provide satisfactory evidence of the required immunizations. Satisfactory evidence means a statement, certificate or record from a physician or other recognized health facility or personnel, stating that the required immunizations have been given to the child and verifying the type of vaccine and the month, day and year of administration.
Correction Required
Child immunization requirements shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-62.202 Nutrition and Food Service
Not Observed
19 CSR 30-62.212 Transportation and Field Trips
Not Observed
19 CSR 30-62.222 Records and Reports
Violation
 Provider Comments
Violation
2 child(ren) records did not include employers' name of parent(s), guardian or legal custodian.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Corrected on Site

Compliance Date
7/13/2020
Violation
2 child(ren) records did not include employers' address of parent(s), guardian or legal custodian.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Corrected on Site

Compliance Date
7/13/2020
Violation
2 child(ren) records did not include work schedule of parent(s), guardian or legal custodian.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Corrected on Site

Compliance Date
7/13/2020
Violation
2 child(ren) records did not include work telephone number of parent(s), guardian or legal custodian.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Corrected on Site

Compliance Date
7/13/2020
Violation
1 child(ren) records did not include child's birth date.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (2) (A) states: The child's full name, address, birth-date and the date care begins and ends;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Corrected on Site

Compliance Date
7/13/2020
19 CSR 30-63.040 Background Screening Findings
Not Observed
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. —
Not Observed
RSMo 210.211.  License required - exceptions - written notice of licensure status, when.
Not Observed