DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

KIDS VILLAGE WEST LLC

002471034

(573) 860-2900

36 TAYLOR ST
SULLIVAN
MO  63080-1934

KIDS VILLAGE WEST LLC



 

PELTON, CARLA SUE

kidsvillagewest@att.net


LEATRICE L DIXON

BIRTH - 12 YEARS

63

GROUP HOME AND CENTER

24 CHILDREN IN THE INFANT/TODDLER UNIT; 8 CHILDREN UNDER 12 MONTHS
 
Inspection Information

02/19/2021

10:10 AM

12:39 PM

UNANNOUNCED

COMPLIANCE MONITORING

2393516401


DocumentDocument-Date
SAMPLE FORMS 07/21/2014
CHILD CARE PRACTICES 05/19/2014
DISCIPLINE POLICIES 05/19/2014
POLICIES 07/21/2014
SAMPLE WEEKLY MENU 06/20/2014
DAILY SCHEDULE 07/21/2014
JOB RESPONSIBILITIES 08/06/2014
LINES OF ADMINISTRATIVE AUTHORITY 05/19/2014
LOCAL BUILDING APPROVAL 07/21/2014
LOCAL ZONING APPROVAL 07/21/2014
LLC ARTICLES OF ORGANIZATION 08/06/2014
LLC OPERATING AGREEMENT 08/06/2014
DIAGRAM/OUTDOOR 10/13/2018
DIAGRAM/INDOOR 10/13/2018
DIRECTOR'S QUALIFICATIONS 03/14/2019
SANITATION INSPECTION 06/16/2020
EQUIPMENT LIST 06/08/2018
STAFF SHEET 06/08/2018
APPLICATION 06/22/2020
SAFE SLEEP POLICY 06/28/2018
DISASTER AND EMERGENCY PREPAREDNESS PLAN 07/31/2018
CERTIFICATE OF GOOD STANDING 06/22/2020
FIRE/SAFETY INSPECTION 03/24/2020

Overlap Start TimeOverlap End TimeOverlap Submit Date
  2:45PM   4:45PM   11/12/2019



Inspection determined facility to be in compliance with licensing rules.
Open Violations: 10
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 11
Total Children 48
StaffChildClass AgeNote
1 4 INFANTS AND TODDLERS Jessica Weisner with children ages 1 to 2 years
2 8 INFANTS AND TODDLERS Ashley Angell and Makoce Bear Runner with children ages 3 months to 1 year
2 9 MIXED Katie Blunda and Juanita Ziegler with children ages 2 to 3 years (7 children are age 2 years)
2 13 MIXED Shawna Wilson and Valley Raby with children ages 2 to 4 (1 child is age 2 years)
2 0 NO CHILDREN IN ATTENDANCE Tracy Arlotta (designated in charge) and Monica Rellig (cook/floater) with no children
2 14 PRESCHOOL Julie Scott and Jessica Tune with children ages 3 to 5 years

 
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
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
Violation
 Provider Comments
Violation
The facility’s list of emergency numbers was not posted in each room.
Licensing Rule Reference
19 CSR 30-62.090 Disaster and Emergency Preparedness (2) (B) 1. B. states: A list of emergency numbers, including 911, if available, the fire department, police department, ambulance service, poison control center, and local radio station;
Correction Required
Facility must post information as required.

Correction Verification
Corrected on Site

Compliance Date
2/19/2021
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
Corrected on Site

Compliance Date
2/19/2021
Violation
The facility's special instructions for infants and non-ambulatory children were not posted in each room.
Licensing Rule Reference
19 CSR 30-62.090 Disaster and Emergency Preparedness (2) (B) 3. states: Any special instructions for infants and non-ambulatory children;
Correction Required
Facility must post information as required.

Correction Verification
Corrected on Site

Compliance Date
2/19/2021
19 CSR 30-62.092 Furniture, Equipment and Materials
Compliance
19 CSR 30-62.102 Personnel
Violation
 Provider Comments
Violation
The facility did not meet requirements for a criminal background check. Results were not on file for the following staff member(s): Makoce Bear Runner, Faith Pelton, Shawna Wilson, Monica Rellig.
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
A caregiver did not obtain one clock hour of training for each month of employment. The staff listed need the following information: Mackoce Bear Runner (needed 5/has 0); Kasen Jones (needed 6/has 4); Faith Pelton (needed 8/has 7.50), Carla Pelton needed 12/has 3.50).
Licensing Rule Reference
19 CSR 30-62.102 Personnel (3) (C) states: Caregivers who were employed after the first of the year shall obtain one (1) clock of hour training for each one (1) month of employment, regardless of the date employment began.
Correction Required
Required training hours shall be documented for each employee.

Correction Verification
Submit Documentation

Compliance Date

Violation
Clock hour training records were not available for review.
Licensing Rule Reference
19 CSR 30-62.102 Personnel (3) (F) 2. states: All clock hour training records shall be recorded in the Missouri Professional Development Registry (MOPD Registry) at www.OPENInitiative.org. A summary of training from the MOPD System will serve as documentation of training hours completed.
Correction Required
Required training hours shall be documented for each employee on the MOPD Registry.

Correction Verification
Submit Documentation

Compliance Date

Violation
Requirements for safe sleep training were not met in that the following staff did not complete department-approved safe sleep training within the past three years: Carla Pelton (not on Toolbox); Tracy Arlotta (no data), Makoce Bear Runner (no data), Valley Raby (no data), Monica Rellig (not on Toolbox).
Licensing Rule Reference
19 CSR 30-62.102 Personnel (4) . states: Safe Sleep Training. Every three (3) years the center director, group child care home provider, all other caregivers, and those volunteers who are counted in staff/child ratios in a group child care home or child care center licensed to provide care for infants less than one (1) year of age shall successfully complete department-approved training regarding the American Academy of Pediatrics (AAP) safe sleep recommendations contained in the American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome. Technical report – SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment, by Moon RY, which is incorporated by reference in this rule as published in PEDIATRICS Volume 128, No. 5, November 1, 2011, and available from the University of Vermont College of Medicine, Given Building S261, 89 Beaumont Avenue, Burlington, Vermont 05405-0068, telephone number 802-656-2505, fax number 802-656-4844, or at www.pediatrics.aapublications.org/content/128/5/1030.full. This rule does not incorporate any subsequent amendments or additions.
Correction Required
Center director, group child care home provider, and other caregivers, and those volunteers counted in staff/child ratios shall complete department approved safe sleep training as required.

Correction Verification
Submit Documentation

Compliance Date

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 Macoke Bear Runner, Kasen Jones, Julie Scott and Monica Rellig 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

Violation
A medical examination report did not include a completed Risk Assessment for Tuberculosis form for Caite Zelch (too old-dated 2015), Tracy Arlotta (incomplete/old assessment), Monica Rellig.
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

Violation
The medical examination report on file was older than 12 months before the individual's begin date at the facility.
Licensing Rule Reference
19 CSR 30-62.122 Medical Examination Reports (1) (C) states: Medical examination reports shall be completed not more than twelve (12) months prior to beginning work in the facility and may be transferable to another day care facility for subsequent employment.
Correction Required
Medical reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

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
Violation
 Provider Comments
Violation
3 child(ren) records did not include date care begins and ends.
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
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

Violation
3 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

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