DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

LUCKY LANE NURSERY SCHOOL ASSOCIATION-BENEVOLENT

000522607

(314) 434-4462

12546 CONWAY RD
ST LOUIS
MO  63141

LUCKY LANE EARLY CHILDHOOD ASSOCIATION



 

CLOSSON, RACHEL LEAH

rachel@luckylane.org

Incorporated

KAYLA TODARO

24 MONTHS - 5 YEARS

80

GROUP HOME AND CENTER

 
Inspection Information

05/24/2021

11:00 AM

3:01 PM

UNANNOUNCED

COMPLIANCE MONITORING

2400726437


DocumentDocument-Date
ANNUAL DECLARATION 04/26/2021
DIRECTOR'S QUALIFICATIONS 01/10/2006
CERTIFICATE OF GOOD STANDING 03/26/2013
SAMPLE FORMS 09/02/1993
REGISTERING FICTITIOUS NAMES 03/26/2013
POLICIES 09/02/1993
LOCAL ZONING APPROVAL 09/02/1993
LOCAL FIRE DEPARTMENT NOTIFICATION 03/01/2011
LOCAL BUILDING APPROVAL 09/02/1993
LINES OF ADMINISTRATIVE AUTHORITY 09/02/1993
JOB RESPONSIBILITIES 09/02/1993
DISCIPLINE POLICIES 09/02/1993
DIAGRAM/OUTDOOR 09/02/1993
DIAGRAM/INDOOR 09/02/1993
CHILD CARE PRACTICES 09/02/1993
ARTICLES OF INCORPORATION 09/02/1993
SAMPLE WEEKLY MENU 04/02/2015
DAILY SCHEDULE 04/02/2015
APPLICATION 04/02/2019
EQUIPMENT LIST 04/26/2021
STAFF SHEET 04/26/2021
FIRE/SAFETY INSPECTION 04/27/2021
SANITATION INSPECTION 05/04/2021




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 9
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 9
Total Children 32
StaffChildClass AgeNote
3 0 NO CHILDREN IN ATTENDANCE Conni Dempsey, Board President, Victoria Sirles, future director, and Rachel Closson, director, were present, however, were not caring for children at the time of the inspection.
2 7 PRESCHOOL Alexa Capps and Stephanie Waser, caregivers, were present and caring for seven children, all two years old or three years old.
1 9 PRESCHOOL Melissa Krause, caregiver, was present and caring for nine children, all five years old, preschool age.
1 6 PRESCHOOL Lori Boyer, caregiver, was present and caring for six children, ages three and four years old.
1 8 PRESCHOOL Kin Wan, caregiver, was present and caring for eight children, all five years old, preschool age.
1 2 PRESCHOOL Julianne Stillman, caregiver, was present and caring for two children, both four years old.

 
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
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
Violation
 Provider Comments
Violation
Background screening information was not available for review for Olivia Michaels was missing the Family Care Safety Registry; Kin Wan and Olivia Michaels were missing the criminal background check/eligibility letter.
Licensing Rule Reference
19 CSR 30-62.102 Personnel (1) (Q) states: Background screening information received by the provider shall be retained in the individual’s file in a confidential manner and available for review.
Correction Required
Background screening information shall be available and kept confidential.

Correction Verification
Submit Documentation

Compliance Date

Violation
A facility orientation was not documented and available for review for all caregivers. The following staff need documentation of a facility orientation: Olivia Michaels.
Licensing Rule Reference
19 CSR 30-62.102 Personnel (1) (K) . states: The child care provider shall ensure that within seven (7) days of employment or volunteering and before being left alone with children that caregivers receive a facility orientation. The child care provider shall ensure that documentation verifying completion of the facility orientation is maintained and on file for review by the department for each caregiver. The facility orientation shall include:
Correction Required
The facility shall ensure that a facility orientation occurs within 7 days and documentation verifying completion is maintained and on file for review by the department for each caregiver.

Correction Verification
Submit Documentation

Compliance Date

Violation
The requirements for obtaining 12 clock hours each calendar year were not met. For the calendar year of 2020, the staff listed need the following information: Erica Farnsworth needs 12 clock hours, Kin Wan needs 5 clock hours, and Casey Gutting needs 12 clock hours.
Licensing Rule Reference
19 CSR 30-62.102 Personnel (3) (A) states: The center director, group child care home provider, all other caregivers, and those volunteers who are counted in staff/child ratios shall obtain at least twelve (12) clock hours of child-care related training during each calendar year. Clock hour training shall be approved by the department.
Correction Required
Required training hours shall be documented for each caregiver.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-62.112 Staff/Child Ratios
Compliance
19 CSR 30-62.122 Medical Examination Reports
Violation
 Provider Comments
Violation
A medical examination report did not include a completed Risk Assessment for Tuberculosis form for Isabella Mourer, Olivia Michaels.
Licensing Rule Reference
19 CSR 30-62.122 Medical Examination Reports (1) (B) . 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

Violation
Medical examination report(s) was/were not on file for Michael Tzinberg, Isabella Mourer, Olivia Michaels as evidenced by a medical examination was not on file within 30 days of an individual beginning to work with children.
Licensing Rule Reference
19 CSR 30-62.122 Medical Examination Reports (1) (A) states: All persons working in a day care facility in any capacity during child care hours, including volunteers counted in staff/child ratios, shall be in good physical and emotional health with no physical or mental conditions which would interfere with child care responsibilities. These persons shall have a medical examination report, signed by a licensed physician or registered nurse who is under the supervision of a licensed physician, on file at the facility at the time of initial licensure or within thirty (30) days following employment.
Correction Required
Medical reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

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
Compliance
19 CSR 30-62.212 Transportation and Field Trips
Compliance
19 CSR 30-62.222 Records and Reports
Violation
 Provider Comments
Violation
Three child(ren) records did not include address of another individual who might be reached in an emergency.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (2) (C) states: Name, address and telephone number of another individual (friend or relative) who might be reached in an emergency when the parent(s), guardian or legal custodian cannot be reached;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
Four child(ren) records did not include work schedule of parent(s), guardian or legal custodian.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
Two child(ren) records did not include child's address.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (2) (A) states: The child's full name, address, birth-date and the date care begins and ends;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
Eight child(ren) records did not include field trip and transportation authorization.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (2) (F) states: Field trip and transportation authorization.
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

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