MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
HALL, JACKIE MYRTLE

Facility DVN
000496557

Phone
(417) 924-8338

Physical Address
2320 HIGHWAY 5
MANSFIELD
MO 65704-8303

Owner
HALL, JACKIE MYRTLE

Mailing Address

Provider/Director
HALL, JACKIE MYRTLE

E-mail Address
jackiehall@centurytel.net

Incorporated

Child Care Specialist
LEAH WHITE

Age Range
BIRTH - 12 YEARS

Capacity
10

Facility Type
FAMILY HOME

Limitations
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; IF ONLY 4 CHILDREN PRESENT, ALL CHILDREN MAY BE UNDER AGE 2 WITH 1 ADULT CAREGIVER

Inspection Information

Date
12/02/2020

Arrival Time
9:00 AM

Departure Time
10:07 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2388889134

Document	Document-Date
FIRE/SAFETY INSPECTION	06/09/2020
APPLICATION	05/11/2020
SANITATION INSPECTION	07/30/2020
ANNUAL DECLARATION	11/06/2020
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	11/06/2020
EQUIPMENT LIST	11/06/2020
DAILY SCHEDULE	03/03/1997
ASSISTANT REFERENCES	08/27/2012
OWNER/PROVIDER REFERENCES	08/13/1996
SAMPLE WEEKLY MENU	08/27/1996
DIAGRAM/OUTDOOR	07/19/1996
DIAGRAM/INDOOR	07/19/1996
ASSISTANT APPROVAL REQUEST	08/27/1996
CHILD CARE/DISCIPLINE POLICIES	09/06/2002
POLICIES	09/06/2002
LOCAL FIRE DEPARTMENT NOTIFICATION	02/13/2018
SAFE SLEEP POLICY	02/13/2018
DISASTER AND EMERGENCY PREPAREDNESS PLAN	02/07/2018

Overlap Start Time	Overlap End Time	Overlap Submit Date
3:40PM	3:55PM	7/30/2012
7:00AM	7:45AM	7/30/2012

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.

Attendance at Time of Inspection

Total Staff 2

Total Children 7

Staff	Child	Class Age	Note
2	7	MIXED	Jackie and Donna were present with seven children and three were under two.


19 CSR 30-61.025 Organization and Administration Compliance
19 CSR 30-61.045 Initial Licensing Information Compliance
19 CSR 30-61.055 Annual Requirements Compliance
19 CSR 30-61.085 Physical Requirements of the Family Day Care Home Compliance
19 CSR 30-61.086 Fire Safety Compliance
19 CSR 30-61.090 Disaster and Emergency Preparedness Compliance
19 CSR 30-61.095 Furniture, Equipment and Materials Compliance
19 CSR 30-61.105 The Day Care Provider and Other Day Care Personnel Compliance
19 CSR 30-61.115 Day Care Family and Household Compliance
19 CSR 30-61.125 Medical Examination Reports Compliance
19 CSR 30-61.135 Admission Policies and Procedures Compliance
19 CSR 30-61.145 Nighttime Care Compliance
19 CSR 30-61.155 Overlap Care of Children Not Observed
19 CSR 30-61.165 Emergency School Closings Not Observed
19 CSR 30-61.175 Child Care Program Compliance
19 CSR 30-61.185 Health Care Compliance
19 CSR 30-61.190 Nutrition and Food Service Compliance
19 CSR 30-61.200 Transportation and Field Trips Compliance
19 CSR 30-61.210 Records and Reports Compliance
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
RSMo 210.252. Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized. Compliance