DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

UNLEASHING POTENTIAL

002390710

(314) 762-9818

4300 MORGANFORD RD
ST LOUIS
MO  63116-1504

UNLEASHING POTENTIAL

1000 N VANDEVENTER AVE 2ND FL
ST LOUIS
MO  63113-3435

HOLLINGSWORTH, JEANIE LAKEASHA

ghampton@upstl.org

Incorporated

KATHERINE D SIMS

5 YEARS - 12 YEARS

60

SCHOOL AGE

 
Inspection Information

11/12/2020

3:20 PM

4:25 PM

UNANNOUNCED

COMPLIANCE MONITORING

2387961642


DocumentDocument-Date
ANNUAL DECLARATION 10/19/2020
LINES OF ADMINISTRATIVE AUTHORITY 12/13/2012
DIRECTOR'S QUALIFICATIONS 10/13/2020
SAMPLE WEEKLY MENU 02/05/2013
SAMPLE FORMS 02/05/2013
POLICIES 02/05/2013
DISCIPLINE POLICIES 02/05/2013
DAILY SCHEDULE 02/05/2013
CHILD CARE PRACTICES 02/05/2013
CERTIFICATE OF GOOD STANDING 11/19/2018
APPLICATION 11/05/2018
EQUIPMENT LIST 11/12/2020
STAFF SHEET 10/19/2020
LOCAL FIRE DEPARTMENT NOTIFICATION 08/02/2018
DISASTER AND EMERGENCY PREPAREDNESS PLAN 11/19/2018




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 7
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 8
StaffChildClass AgeNote
2 0 NO CHILDREN IN ATTENDANCE Jeanie Hollingsworth and Robin Cole present with no children in attedance
1 8 SCHOOL AGE Gundia Lock -Clay present with 8 children, ages 5-9yrs old

 
19 CSR 30-62.032 Organization and Administration
Compliance
19 CSR 30-62.042 Initial Licensing Information
Compliance
19 CSR 30-62.052 Annual Requirements
Violation
 Provider Comments
Violation
The Family Care Safety Registry check was not conducted for Jeanie Hollingsworth, Gundia Lock-Clay, Wanda Cannon, and Lynn Tiede within thirty (30) days prior to the anniversary date.
Licensing Rule Reference
19 CSR 30-62.052 Annual Requirements (2) (C) states: The child care provider shall conduct a Family Care Safety Registry check for all child care staff members within thirty (30) days prior to the anniversary date as printed on the license.
Correction Required
Required Family Care Safety Registry checks shall be conducted for all child care staff member(s) within thirty (30) days prior to the anniversary date.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-62.082 Physical Requirements of Group Day Care Homes and Day Care Centers
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
Compliance
19 CSR 30-62.112 Staff/Child Ratios
Compliance
19 CSR 30-62.122 Medical Examination Reports
Violation
 Provider Comments
Violation
Medical examination report did not include a completed Risk Assessment for Tuberculosis form for Jeanie Hollingsworth (not fully complete).
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
Corrected on Site

Compliance Date
11/12/2020
19 CSR 30-62.132 Admission Policies and Procedures
Violation
 Provider Comments
Violation
An individualized plan for specialized care for a child with special physical, developmental or behavioral needs was not on file.
Licensing Rule Reference
19 CSR 30-62.132 Admission Policies and Procedures (6) states: A child who has a special physical, developmental or behavioral need shall have on file an individualized plan for specialized care from a professionally qualified source.
Correction Required
An individualized plan from a professional source shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility did not meet requirements for child enrollment and health information as evidenced by Child A, Child B, Child C, Child D, Child E, and Child F did not have authorization for emergency medical care.
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
Submit Documentation

Compliance Date

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
Violation
 Provider Comments
Violation
1 child(ren) records did not include home 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
Submit Documentation

Compliance Date

Violation
4 child(ren) records did not include address of another individual who might be reached in an emergency.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (2) (C) states: Name, address and telephone number of another individual (friend or relative) who might be reached in an emergency when the parent(s), guardian or legal custodian cannot be reached;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
1 child(ren) records did not include field trip and transportation authorization.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (2) (F) states: Field trip and transportation authorization.
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

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
Submit Documentation

Compliance Date

19 CSR 30-63.020 General Requirements
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