MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
MICKENS, CYNTHIA LORRAYNE

Facility DVN
000402755

Phone
(816) 921-0526

Physical Address
3943 PASEO BLVD
KANSAS CITY
MO 64110-1311

Owner
MICKENS, CYNTHIA LORRAYNE

Mailing Address

Provider/Director
MICKENS, CYNTHIA LORRAYNE

E-mail Address
cmickenspoj@gmail.com

Incorporated

Child Care Specialist
CHRISTINA BRUCE

Age Range
BIRTH - 12 YEARS

Capacity
10

Facility Type
FAMILY HOME

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

Inspection Information

Date
02/02/2021

Arrival Time
12:53 PM

Departure Time
2:27 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2401942360

Document	Document-Date
ANNUAL DECLARATION	02/02/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	02/02/2021
ASSISTANT APPROVAL REQUEST	01/22/2016
CHILD CARE/DISCIPLINE POLICIES	01/31/2008
DAILY SCHEDULE	01/30/2008
SAMPLE WEEKLY MENU	08/24/1990
DIAGRAM/INDOOR	10/30/2007
DIAGRAM/OUTDOOR	10/30/2007
POLICIES	01/31/2008
APPLICATION	12/09/2019
EQUIPMENT LIST	02/02/2021
SANITATION INSPECTION	11/18/2020
FIRE/SAFETY INSPECTION	11/13/2020

Inspection determined facility to be in compliance with licensing rules.

Open Violations: 1

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 2

Total Children 7

Staff	Child	Class Age	Note
2	7	MIXED	Cynthia Mickens (provider) and Brittany Jackson, assistant, are with 7 children, 3 under 2 years old (3-one year olds, 1-two year old, 2-three year olds, and 1-seven year old).