MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
MARTIN, KIMBERLY

Facility DVN
000601165

Phone
(573) 779-3502

Physical Address
10350 WEBSTER ROAD
CALEDONIA
MO 63631

Owner
MARTIN, KIMBERLY

Mailing Address

Provider/Director
MARTIN, KIMBERLY

E-mail Address
billykim1216@hotmail.com

Incorporated

Child Care Specialist
BRITTANY HECHT

Age Range
6 WEEKS - 12 YEARS

Capacity
10

Facility Type
FAMILY HOME

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

Inspection Information

Date
05/11/2021

Arrival Time
10:58 AM

Departure Time
11:59 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2399625115

Document	Document-Date
ANNUAL DECLARATION	03/04/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	03/04/2021
OWNER/PROVIDER REFERENCES	03/04/1994
DAILY SCHEDULE	04/14/1994
SAMPLE WEEKLY MENU	04/14/1994
POLICIES	05/11/1994
CHILD CARE/DISCIPLINE POLICIES	05/11/1994
DIAGRAM/INDOOR	05/11/1994
DIAGRAM/OUTDOOR	05/11/1994
ASSISTANT REFERENCES	01/19/2010
ASSISTANT APPROVAL REQUEST	03/04/2016
EQUIPMENT LIST	03/04/2021
APPLICATION	03/01/2018
SAFE SLEEP POLICY	10/11/2017
FIRE/SAFETY INSPECTION	02/02/2021
SANITATION INSPECTION	04/16/2021

Overlap Start Time	Overlap End Time	Overlap Submit Date
3:15PM	5:15PM	2/11/2014

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 1

Total Children 7

Staff	Child	Class Age	Note
1	7	MIXED	Kim Martin, Provider 2 - 18-19 Month Olds 1 - 2 Year Old 4 - 3-5 Year Olds


19 CSR 30-61.025 Organization and Administration Compliance
19 CSR 30-61.045 Licensing Process 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 Child Care Provider and Other Child 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 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