DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

APPLE BLOSSOM LEARNING CENTER LLC

002813807

(417) 349-0063

1505A N MAIN ST
MOUNTAIN GROVE
MO  65711-1038

APPLE BLOSSOM LEARNING CENTER LLC



 

SMART, SHANNON DAWN

dsmart1304@hotmail.com


ELAINE S COX

BIRTH - 12 YEARS

28

GROUP HOME AND CENTER

5 CHILDREN UNDER 12 MONTHS; 8 CHILDREN UNDER 24 MONTHS
 
Inspection Information

11/12/2020

12:53 PM

1:51 PM

UNANNOUNCED

SUPPLEMENTAL

2387511842


DocumentDocument-Date
LINES OF ADMINISTRATIVE AUTHORITY 03/03/2020
JOB RESPONSIBILITIES 02/10/2020
SAMPLE WEEKLY MENU 02/10/2020
SANITATION INSPECTION 02/27/2020
DISASTER AND EMERGENCY PREPAREDNESS PLAN 01/30/2020
POLICIES 02/10/2020
CHILD CARE PRACTICES 01/02/2020
CERTIFICATE OF GOOD STANDING 01/02/2020
STAFF SHEET 01/02/2020
DISCIPLINE POLICIES 01/02/2020
SAMPLE FORMS 01/02/2020
LOCAL FIRE DEPARTMENT NOTIFICATION 01/02/2020
DIAGRAM/OUTDOOR 01/02/2020
DIAGRAM/INDOOR 01/02/2020
LLC ARTICLES OF ORGANIZATION 11/11/2019
APPLICATION 01/09/2020
FIRE/SAFETY INSPECTION 01/23/2020
DIRECTOR'S QUALIFICATIONS 03/23/2020
DAILY SCHEDULE 01/23/2020
EQUIPMENT LIST 01/23/2020
LLC OPERATING AGREEMENT 03/03/2020
LOCAL BUILDING APPROVAL 03/03/2020
LOCAL ZONING APPROVAL 03/03/2020

Overlap Start TimeOverlap End TimeOverlap Submit Date
  3:00PM   5:00PM   5/21/2020



Inspection determined facility to be in compliance with licensing rules.
Open Violations: 4
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 3
Total Children 15
StaffChildClass AgeNote
1 4 INFANTS AND TODDLERS Kortnie Bunch
2 11 MIXED Children ages 2 year to 4 years, (3-2 year olds) Shannon Smart and Rita Baker

 
19 CSR 30-62.032 Organization and Administration
Not Observed
19 CSR 30-62.042 Initial Licensing Information
Violation
 Provider Comments
Violation
The name, address and telephone number of the LLC member(s) was not prominently posted near the license.
Licensing Rule Reference
19 CSR 30-62.042 Initial Licensing Information (2) (O) states: The name(s), address(es), and telephone number(s) of the facility owner(s), or the board president or chairperson, members of an LLC, or his/her designee shall be posted prominently near the license.
Correction Required
The name, address, and phone number of the owner/board president/chairperson/LLC members/designee shall be posted.

Correction Verification
Submit Documentation

Compliance Date
11/5/2020
Violation
Posting requirements were not met as evidenced by the license was not posted near the entrance.
Licensing Rule Reference
19 CSR 30-62.042 Initial Licensing Information (2) (N) states: The official license shall be granted for up to two (2) years and may be renewed upon reapplication and inspection. The official license shall be posted near the entrance of the facility where it may be seen easily by parents or others who visit.
Correction Required
The official license shall be posted.

Correction Verification
Submit Documentation

Compliance Date
11/5/2020
19 CSR 30-62.052 Annual Requirements
Not Observed
19 CSR 30-62.082 Physical Requirements of Group Day Care Homes and Day Care Centers
Violation
 Provider Comments
Violation
The premises were not safe and suitable as evidenced by chest freezer located in the walkway for the infant/toddlers to get to the outdoor play space was not locked, this model did not have a lock.
Licensing Rule Reference
19 CSR 30-62.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (A) states: The premises shall be safe and suitable for the care of children.
Correction Required
The premises shall be safe and suitable for the care of children.

Correction Verification
Submit Documentation

Compliance Date
11/5/2020
Violation
Stairways in the child care space did not meet requirements as evidenced by there was no safety gate.
Licensing Rule Reference
19 CSR 30-62.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (F) states: Approved safety gates at stairways and doors shall be provided and used as needed.
Correction Required
Stairways shall meet safety standards as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The requirements for protective outlet covers or twist-lock outlets were not met as evidenced by electrical outlets were not covered in that electrical outlets in walk way to the outdoor play space in the infant/toddler area was observed not covered.
Licensing Rule Reference
19 CSR 30-62.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (G) states: Protective outlet covers or twist-lock outlets shall be used in areas accessible to the children.
Correction Required
The facility shall use outlet covers or twist-lock outlets as required.

Correction Verification
Submit Documentation

Compliance Date
11/9/2020
19 CSR 30-62.087 Fire Safety
Not Observed
19 CSR 30-62.090 Disaster and Emergency Preparedness
Violation
 Provider Comments
Violation
The facility's evacuation route diagram was not posted in each room.
Licensing Rule Reference
19 CSR 30-62.090 Disaster and Emergency Preparedness (2) (B) 2. states: A diagram of evacuation routes from the room;
Correction Required
Facility must post information as required.

Correction Verification
Submit Documentation

Compliance Date
11/5/2020
19 CSR 30-62.092 Furniture, Equipment and Materials
Not Observed
19 CSR 30-62.102 Personnel
Violation
 Provider Comments
Violation
A facility orientation was not conducted for a caregiver(s) before being left alone with children. The following staff need a facility orientation: Kortnie Bunch, Jaysa Bunch. and Michelle Collins.
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
11/9/2020
Violation
A facility orientation was not conducted for a caregiver(s) before being left alone with children. The following staff need a facility orientation: Rita Bunch.
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

Violation
The facility did not meet requirements for a criminal background check. Results were not on file for the following staff member(s): Rita Barker.
Licensing Rule Reference
19 CSR 30-62.102 Personnel (1) (M) states: Child care staff members shall have qualifying background screening results on file as required by 19 CSR 30-63.020 General Requirements.
Correction Required
Required results of criminal background checks shall be on file.

Correction Verification
Submit Documentation

Compliance Date

Violation
Prospective child care staff member(s), Kortnie Bunch, was/were not supervised at all times by another child care staff member who received a qualifying result on the criminal background check within the past five years.
Licensing Rule Reference
19 CSR 30-62.102 Personnel (1) (O) states: A prospective child care staff member may begin work for a child care provider after the criminal background check has been requested from the department; however, pending completion of the criminal background check, the prospective child care staff member shall be supervised at all times by another child care staff member who received a qualifying result on the criminal background check within the past five (5) years.
Correction Required
All prospective child care staff member(s) who have requested a criminal background check shall be supervised at all times by another child care staff member who has received a qualifying result on the criminal background check within the past five years.

Correction Verification
Submit Documentation

Compliance Date
11/5/2020
Violation
The facility did not meet requirements for a criminal background check. Results were not on file for the following staff member(s): Kortnie Bunch.
Licensing Rule Reference
19 CSR 30-62.102 Personnel (1) (M) states: Child care staff members shall have qualifying background screening results on file as required by 19 CSR 30-63.020 General Requirements.
Correction Required
Required results of criminal background checks shall be on file.

Correction Verification
Submit Documentation

Compliance Date
11/5/2020
19 CSR 30-62.112 Staff/Child Ratios
Not Observed
19 CSR 30-62.122 Medical Examination Reports
Violation
 Provider Comments
Violation
Medical examination report(s) was/were not on file for Jaysa Bunch, and Kortnie Bunch 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
11/9/2020
Violation
A medical examination report did not include a completed Risk Assessment for Tuberculosis form for Michelle Collins, Jaysa Bunch and Kortnie Bunch.
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

19 CSR 30-62.132 Admission Policies and Procedures
Not Observed
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
Violation
 Provider Comments
Violation
The use of diapering products did not meet requirements as evidenced by diapering product(s) were not labeled with the child’s name.
Licensing Rule Reference
19 CSR 30-62.182 Child Care Program (1) (E) 1. states: Disposable tissues or wipes shall be used to cleanse the child at each time of diapering. Any diapering creams, powders, or other products applied at the time of diapering shall be provided by the parent(s) and labeled with the child's name.
Correction Required
Diapering products shall be provided by parents and labeled with the child's name.

Correction Verification
Submit Documentation

Compliance Date
11/9/2020
19 CSR 30-62.192 Health Care
Violation
 Provider Comments
Violation
Requirements for immunization reports on file were not met as evidenced by 1 immunization record(s) was/were not on file.
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
11/5/2020
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
Not Observed
19 CSR 30-63.020 General Requirements
Not Observed
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. —
Not Observed
RSMo 210.211.  License required - exceptions - written notice of licensure status, when.
Not Observed