DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

SOUTH CENTRAL MISSOURI COMMUNITY ACTION AGENCY

000606982

(573) 996-5059

ROUTE 2, BOX 16
DONIPHAN
MO  63935

SOUTH CENTRAL MISSOURI COMMUNITY ACTION AGENCY

PO BOX 246
DONIPHAN
MO  63935-0246

ROBERTS, AMANDA RENEE

aroberts@scmcaa.org

Incorporated

JESSICA SPENCER

36 MONTHS - 5 YEARS

74

GROUP HOME AND CENTER

 
Inspection Information

05/20/2021

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2400349346


DocumentDocument-Date
DISASTER AND EMERGENCY PREPAREDNESS PLAN 05/19/2020
LOCAL ZONING APPROVAL 04/23/2013
CHILD CARE PRACTICES 08/18/2005
DAILY SCHEDULE 08/18/2005
DIAGRAM/INDOOR 09/20/2010
DIAGRAM/OUTDOOR 09/20/2010
DISCIPLINE POLICIES 08/18/2005
LINES OF ADMINISTRATIVE AUTHORITY 08/18/2005
POLICIES 08/18/2005
SAMPLE WEEKLY MENU 08/18/2005
JOB RESPONSIBILITIES 08/18/2005
DIRECTOR'S QUALIFICATIONS 03/17/2015
CERTIFICATE OF GOOD STANDING 03/27/2019
ARTICLES OF INCORPORATION 03/27/2019
APPLICATION 03/27/2019
EQUIPMENT LIST 05/16/2019
STAFF SHEET 05/16/2019
FIRE/SAFETY INSPECTION 09/03/2020
SANITATION INSPECTION 09/25/2020




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.

 
19 CSR 30-62.032 Organization and Administration
Compliance
19 CSR 30-62.042 Licensing Process
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
Violation
 Provider Comments
Violation
The walls located in Room 1 was/were not in good condition as evidenced by there were four small holes located near the light switch.
Licensing Rule Reference
19 CSR 30-62.082 Physical Requirements of Group Day Care Homes and Day Care Centers (2) (A) 6. states: Walls, ceilings and floors shall be finished with material which can be cleaned easily and shall be free of splinters, cracks and chipping paint. Floor covering shall be in good condition. Lead-free paint shall be used for all painted surfaces.
Correction Required
Walls, ceilings, and floors shall be made of approved materials, easily cleaned and in good condition.

Correction Verification
Submit Documentation

Compliance Date
5/12/2021
Violation
The walls located in Room 3 was/were not in good condition as evidenced by the wall located between the restrooms had small holes. There were also small holes located in each restroom near the toilet paper holder.
Licensing Rule Reference
19 CSR 30-62.082 Physical Requirements of Group Day Care Homes and Day Care Centers (2) (A) 6. states: Walls, ceilings and floors shall be finished with material which can be cleaned easily and shall be free of splinters, cracks and chipping paint. Floor covering shall be in good condition. Lead-free paint shall be used for all painted surfaces.
Correction Required
Walls, ceilings, and floors shall be made of approved materials, easily cleaned and in good condition.

Correction Verification
Submit Documentation

Compliance Date
5/12/2021
Violation
The walls located in Room 2 was/were not in good condition as evidenced by six small holes were located in the restroom wall.
Licensing Rule Reference
19 CSR 30-62.082 Physical Requirements of Group Day Care Homes and Day Care Centers (2) (A) 6. states: Walls, ceilings and floors shall be finished with material which can be cleaned easily and shall be free of splinters, cracks and chipping paint. Floor covering shall be in good condition. Lead-free paint shall be used for all painted surfaces.
Correction Required
Walls, ceilings, and floors shall be made of approved materials, easily cleaned and in good condition.

Correction Verification
Submit Documentation

Compliance Date
5/12/2021
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
Violation
 Provider Comments
Violation
Medical examination report form did not contain all required information as evidenced by one staff member had the appropriate form on file; however, the medical provider did not complete the limitation section.
Licensing Rule Reference
19 CSR 30-62.122 Medical Examination Reports (1) (D) states: The medical examination report form shall be supplied by the department or the facility may use its own form if it contains all the information on the department's form.
Correction Required
Medical reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date
5/12/2021
19 CSR 30-62.132 Admission Policies and Procedures
Violation
 Provider Comments
Violation
The facility did not meet requirements for child enrollment and health information on file as evidenced by one child(s) file(s) did not have the parental acknowledgement they have been notified that they may request whether there are children for whom an immunization exemption has been filed for currently enrolled in or attending the facility.
Licensing Rule Reference
19 CSR 30-62.132 Admission Policies and Procedures (8) (E) 8. F. states: They have been notified that they may request notice at initial enrollment in or attendance at the facility or upon request of whether there are children for whom an immunization exemption has been filed currently enrolled in or attending the facility
Correction Required
Child enrollment information shall be completed and on file as requested.

Correction Verification
Submit Documentation

Compliance Date
5/12/2021
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
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