DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

THE GODDARD SCHOOL - LAKEWOOD

002796701

(816) 293-9393

3301 NE RALPH POWELL RD
LEES SUMMIT
MO  64064-2368

TEN FIVE LLC

309 NE DARTMORE CT
LEES SUMMIT
MO  64064-1601

MICEK, MELISSA M

LEESSUMMIT3MO@GODDARDSCHOOLS.COM


JONI BEEM

6 WEEKS - 12 YEARS

174

GROUP HOME AND CENTER

32 CHILDREN IN THE INFANT/TODDLER UNIT; 12 CHILDREN UNDER 12 MONTHS
 
Inspection Information

08/06/2021

10:15 AM

12:21 PM

UNANNOUNCED

COMPLIANCE MONITORING

2405853193


DocumentDocument-Date
SANITATION INSPECTION 05/04/2021
ANNUAL DECLARATION 06/09/2021
DIRECTOR'S QUALIFICATIONS 08/08/2020
SAMPLE FORMS 07/17/2020
POLICIES 07/16/2020
LLC ARTICLES OF ORGANIZATION 09/08/2019
LINES OF ADMINISTRATIVE AUTHORITY 07/15/2020
JOB RESPONSIBILITIES 07/15/2020
LLC OPERATING AGREEMENT 05/07/2020
FIRE/SAFETY INSPECTION 06/11/2020
SAMPLE WEEKLY MENU 05/26/2020
CHILD CARE PRACTICES 07/16/2020
DAILY SCHEDULE 06/28/2020
DISCIPLINE POLICIES 07/16/2020
DISASTER AND EMERGENCY PREPAREDNESS PLAN 07/20/2020
LOCAL FIRE DEPARTMENT NOTIFICATION 07/15/2020
LOCAL ZONING APPROVAL 07/15/2020
LOCAL BUILDING APPROVAL 07/15/2020
SAFE SLEEP POLICY 07/16/2020
STAFF SHEET 07/20/2020
DIAGRAM/OUTDOOR 06/22/2020
DIAGRAM/INDOOR 06/22/2020
APPLICATION 07/14/2020




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 22
Total Children 111
StaffChildClass AgeNote
2 6 INFANTS AND TODDLERS under 1 year olds Jenni Kirby and Dottie Pollard
1 4 INFANTS AND TODDLERS 11 months-15 months Merriel Stebbins
2 7 INFANTS AND TODDLERS 1 year old, Micha Allen and Makayla Hicks
4 0 NO CHILDREN IN ATTENDANCE Brandi Backus (chef), Mitzi Micek (director) Abby Hendren (managing member) and Laura Neely (director of operations)
2 13 PRESCHOOL 3-4 year olds, Cara Enke and Tanner Kremeier
3 18 PRESCHOOL 3-4 year olds Kelly Price and Anna Cardello and Roma Dobson
2 19 PRESCHOOL 4-5 year olds Shyann Brown and Kayla Mark
2 16 PRESCHOOL 3-4 year olds, Isabelle Passantino and Mahala Miller
2 14 PRESCHOOL 4-5 year olds, Amanda Balich and Makayla McNeal
2 14 TWO YEAR OLDS Amanda Kirby and Emmalee Rasco

 
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 Cabin 5 was/were not in good condition as evidenced by peeling paint.
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

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
Safe sleep training was not completed within the past 3 years for the following staff Amanda Balich, Kayla Mark, Mahala Miller, Isabella Passantino, and Hailey Whitten.
Licensing Rule Reference
19 CSR 30-62.102 Personnel (4) . states: Safe Sleep Training. Every three (3) years the center director, group child care home provider, all other caregivers, and those volunteers who are counted in staff/child ratios in a group child care home or child care center licensed to provide care for infants less than one (1) year of age shall successfully complete department-approved training regarding the American Academy of Pediatrics (AAP) safe sleep recommendations contained in the American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome. Technical report – SIDS and other sleep-related infant deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment, by Moon RY, which is incorporated by reference in this rule as published in PEDIATRICS Volume 138, No. 5, November 1, 2016 and available at http://pediatrics.aappublications.org/content/pediatrics/early/2016/10/20/peds.2016-2938.full.pdf. This rule does not incorporate any subsequent amendments or additions.
Correction Required
The director, group home provider, other caregivers, and those volunteers counted in staff/child ratio, shall complete department approved safe sleep training as required.

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
Medical examination report(s) was/were not on file for Holly Johnson as evidenced by a medical examination was not on file at the facility at the time of initial licensure.
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
Not Observed
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