DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT
Facility Information

PAPER MOON NURSERY LLC

002692706

(573) 289-2151

551 SOUTHAMPTON DR
COLUMBIA
MO  65203-3057

PAPER MOON NURSERY LLC



 

GERNER, MELISSA ANNE

jackiebnichols@gmail.com


LEKEL LYONS

BIRTH - 2 YEARS

8

FAMILY HOME

8 CHILDREN UNDER 24 MONTHS; UP TO 8 CHILDREN IN CARE, ALL CHILDREN MAY BE UNDER AGE 2 WITH 2 ADULT CAREGIVERS; IF ONLY 4 CHILDREN PRESENT, ALL CHILDREN MAY BE UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 6 CHILDREN IN CARE NO MORE THAN 3 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 8 CHILDREN IN CARE NO MORE THAN 2 UNDER 2 W/ 1 CAREGIVER
 
Inspection Information

03/09/2021

9:48 AM

10:58 AM

UNANNOUNCED

COMPLIANCE MONITORING

2395812363


DocumentDocument-Date
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 01/28/2021
ANNUAL DECLARATION 01/28/2021
APPLICATION 11/20/2019
ASSISTANT APPROVAL REQUEST 03/06/2018
ARTICLES OF INCORPORATION 01/19/2018
CHILD CARE/DISCIPLINE POLICIES 03/06/2018
DISASTER AND EMERGENCY PREPAREDNESS PLAN 03/06/2018
DIAGRAM/INDOOR 03/06/2018
EQUIPMENT LIST 02/08/2018
POLICIES 02/08/2018
DAILY SCHEDULE 02/08/2018
LLC OPERATING AGREEMENT 03/06/2018
SAFE SLEEP POLICY 02/08/2018
SAMPLE FORMS 02/08/2018
OWNER/PROVIDER REFERENCES 03/06/2018
SAMPLE WEEKLY MENU 02/08/2018
SANITATION INSPECTION 11/20/2020
LLC ARTICLES OF ORGANIZATION 01/19/2018
FIRE/SAFETY INSPECTION 12/08/2020




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 5
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 6
StaffChildClass AgeNote
2 6 INFANTS AND TODDLERS Brittany Wallsmith and Kim Hildeabrand were the caregivers of children age ranging 2 months-1 year old

 
19 CSR 30-61.025 Organization and Administration
Compliance
19 CSR 30-61.045 Licensing Process
Compliance
19 CSR 30-61.055 Annual Requirements
Violation
 Provider Comments
Violation
The Family Care Safety Registry check was not conducted for Brittney Wallsmith and Kim Hildebrand within thirty (30) days prior to the anniversary date.
Licensing Rule Reference
19 CSR 30-61.055 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

Violation
The equipment list was not submitted.
Licensing Rule Reference
19 CSR 30-61.055 Annual Requirements (1) (B) states: A current list of available equipment.
Correction Required
The child care provider shall submit an equipment list as required.

Correction Verification
Submit Documentation

Compliance Date

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
Violation
 Provider Comments
Violation
Requirements for the crib mattress/playpen pad/bedding were not met as evidenced by a non-fitted sheet was used.
Licensing Rule Reference
19 CSR 30-61.095 Furniture, Equipment and Materials 1 (B) 2 C states: The crib mattress or playpen pad shall be sized correctly to the crib or playpen, in good condition, waterproof and kept clean and dry, be firm and maintain its shape even when the fitted sheet designated for that model is used, such that there are no gaps between the mattress and the side of the crib or playpen. Only fitted sheets shall be used and shall be changed immediately when soiled or wet.
Correction Required
Sleeping equipment shall meet safety and sanitation requirements.

Correction Verification
Corrected on Site

Compliance Date
3/9/2021
19 CSR 30-61.105 The Child Care Provider and Other Child Care Personnel
Violation
 Provider Comments
Violation
The requirements for first aid and CPR certification were not met as evidenced by there was no documentation on file showing completion of age-appropriate first aid certification.
Licensing Rule Reference
19 CSR 30-61.105 The Child Care Provider and Other Child Care Personnel (1) (S) states: The provider shall have documentation on file at the home of current certification in age-appropriate first aid and cardiopulmonary resuscitation (CPR) training. The training shall be certified by a nationally-recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification, include an in-person skills assessment, and be approved by the department. At least one (1) caregiver with current certification in age-appropriate first aid and CPR must be on site at all times when children are present. First aid/CPR training may count toward the annual clock hour training requirement.
Correction Required
Required age-appropriate certification in first aid/CPR shall be on file, with at least one caregiver with certification on site.

Correction Verification
Submit Documentation

Compliance Date

Violation
The requirements for first aid and CPR certification were not met as evidenced by there was no documentation on file showing completion of age-appropriate CPR certification.
Licensing Rule Reference
19 CSR 30-61.105 The Child Care Provider and Other Child Care Personnel (1) (S) states: The provider shall have documentation on file at the home of current certification in age-appropriate first aid and cardiopulmonary resuscitation (CPR) training. The training shall be certified by a nationally-recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification, include an in-person skills assessment, and be approved by the department. At least one (1) caregiver with current certification in age-appropriate first aid and CPR must be on site at all times when children are present. First aid/CPR training may count toward the annual clock hour training requirement.
Correction Required
Required age-appropriate certification in first aid/CPR shall be on file, with at least one caregiver with certification on site.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-61.115 Day Care Family and Household
Compliance
19 CSR 30-61.125 Medical Examination Reports
Violation
 Provider Comments
Violation
A medical examination report did not include a completed Risk Assessment for Tuberculosis form for Kim Hildebrand .
Licensing Rule Reference
19 CSR 30-61.125 Medical Examination Reports (1) (E) . 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 30-61.135 Admission Policies and Procedures
Compliance
19 CSR 30-61.145 Nighttime Care
Compliance
19 CSR 30-61.155 Overlap Care of Children
Compliance
19 CSR 30-61.165 Emergency School Closings
Compliance
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