DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

CDI HEAD START

002780478

(660) 717-2007

311 W 1ST ST
ADRIAN
MO  64720-9239

CDI HEAD START

702 E OHIO ST STE 15
CLINTON
MO  64735-2362

SHELTON, FELICIA

dsmith@cditeam.org

Incorporated

BILLIE RUSSELL

36 MONTHS - 5 YEARS

20

GROUP HOME AND CENTER

 
Inspection Information

05/18/2021

9:45 AM

10:55 AM

UNANNOUNCED

COMPLIANCE MONITORING

2400233261


DocumentDocument-Date
APPLICATION 06/20/2019
DIAGRAM/INDOOR 07/25/2019
DIAGRAM/OUTDOOR 07/25/2019
EQUIPMENT LIST 07/25/2019
STAFF SHEET 07/25/2019
ARTICLES OF INCORPORATION 06/20/2019
CERTIFICATE OF GOOD STANDING 07/03/2019
CHILD CARE PRACTICES 06/20/2019
DAILY SCHEDULE 06/20/2019
DIRECTOR'S QUALIFICATIONS 08/23/2019
DISASTER AND EMERGENCY PREPAREDNESS PLAN 07/26/2019
DISCIPLINE POLICIES 06/20/2019
JOB RESPONSIBILITIES 06/20/2019
LINES OF ADMINISTRATIVE AUTHORITY 06/20/2019
LOCAL BUILDING APPROVAL 06/20/2019
LOCAL ZONING APPROVAL 07/12/2019
SAFE SLEEP POLICY 06/20/2019
POLICIES 06/20/2019
SAMPLE FORMS 06/20/2019
SAMPLE WEEKLY MENU 07/26/2019
LOCAL FIRE DEPARTMENT NOTIFICATION 07/26/2019
SANITATION INSPECTION 12/09/2020
FIRE/SAFETY INSPECTION 01/28/2021




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 3
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 5
StaffChildClass AgeNote
3 5 PRESCHOOL Amy Frazier, Judy Moles and Lois Hastings

 
19 CSR 30-62.032 Organization and Administration
Compliance
19 CSR 30-62.042 Licensing Process
Compliance
19 CSR 30-62.052 Annual Requirements
Violation
 Provider Comments
Violation
The Annual Declaration was not submitted.
Licensing Rule Reference
19 CSR 30-62.052 Annual Requirements (1) (A) states: An Annual Declaration for Licensed Facility form, promulgated as of 2020 and incorporated by reference in this rule. As published by the Missouri Department of Health and Senior Services, PO Box 570, Jefferson City, MO 65102-0570 and available by the department at https://health.mo.gov/safety/childcare/forms.php indicating the licensee’s intent to continue operating a licensed group child care home or child care center and agreement to comply with all statutes and department licensing rules.
Correction Required
The facility shall submit the Annual Declaration as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The equipment list was not submitted.
Licensing Rule Reference
19 CSR 30-62.052 Annual Requirements (1) (C) states: A current list of available equipment.
Correction Required
The facility shall submit an equipment list as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The staff sheet was not submitted.
Licensing Rule Reference
19 CSR 30-62.052 Annual Requirements (1) (D) states: A current staff sheet.
Correction Required
The facility shall submit a current staff sheet as required.

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 30-62.087 Fire Safety
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
Compliance
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
Not Observed
19 CSR 30-62.212 Transportation and Field Trips
Compliance
19 CSR 30-62.222 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