MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
MICKELSON, KRISTINA LYNN

Facility DVN
001838177

Phone
(573) 202-9925

Physical Address
11075 WOODALE DR
ROLLA
MO 65401

Owner
MICKELSON, KRISTINA LYNN

Mailing Address

Provider/Director

E-mail Address
krissmickelson75@gmail.com

Incorporated

Child Care Specialist
SHELBY N KOETTING

Age Range
BIRTH - 13 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
05/13/2021

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2400549585

Document	Document-Date
OWNER/PROVIDER REFERENCES	02/23/2004
SAMPLE WEEKLY MENU	05/05/2004
SAMPLE FORMS	02/02/2004
DAILY SCHEDULE	02/02/2004
CHILD CARE/DISCIPLINE POLICIES	02/02/2004
POLICIES	02/02/2004
DIAGRAM/OUTDOOR	07/30/2004
DIAGRAM/INDOOR	07/30/2004
ASSISTANT APPROVAL REQUEST	05/25/2010
APPLICATION	08/18/2020
EQUIPMENT LIST	09/28/2020
FIRE/SAFETY INSPECTION	06/17/2020
SANITATION INSPECTION	06/22/2020

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 30-61.025 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 Violation
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