MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT

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Facility Information

Facility Name
KIDS VILLAGE WEST LLC

Facility DVN
002471034

Phone
(573) 860-2900

Physical Address
36 TAYLOR ST
SULLIVAN
MO 63080-1934

Owner
KIDS VILLAGE WEST LLC

Mailing Address

Provider/Director
PELTON, CARLA SUE

E-mail Address
kidsvillagewest@att.net

Incorporated

Child Care Specialist
LEATRICE L DIXON

Age Range
BIRTH - 12 YEARS

Capacity
63

Facility Type
GROUP HOME AND CENTER

Limitations
24 CHILDREN IN THE INFANT/TODDLER UNIT; 8 CHILDREN UNDER 12 MONTHS

Inspection Information

Date
08/19/2021

Arrival Time
10:00 AM

Departure Time
12:37 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2406739834

Document	Document-Date
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	08/19/2021
ANNUAL DECLARATION	08/19/2021
SAMPLE FORMS	07/21/2014
CHILD CARE PRACTICES	05/19/2014
DISCIPLINE POLICIES	05/19/2014
POLICIES	07/21/2014
SAMPLE WEEKLY MENU	06/20/2014
DAILY SCHEDULE	07/21/2014
JOB RESPONSIBILITIES	08/06/2014
LINES OF ADMINISTRATIVE AUTHORITY	05/19/2014
LOCAL BUILDING APPROVAL	08/19/2021
LOCAL ZONING APPROVAL	08/19/2021
LLC ARTICLES OF ORGANIZATION	08/06/2014
LLC OPERATING AGREEMENT	08/06/2014
DIAGRAM/OUTDOOR	10/13/2018
DIAGRAM/INDOOR	10/13/2018
DIRECTOR'S QUALIFICATIONS	03/14/2019
SANITATION INSPECTION	05/03/2021
EQUIPMENT LIST	08/19/2021
STAFF SHEET	06/08/2018
APPLICATION	06/22/2020
SAFE SLEEP POLICY	06/28/2018
DISASTER AND EMERGENCY PREPAREDNESS PLAN	07/31/2018
CERTIFICATE OF GOOD STANDING	08/19/2021
FIRE/SAFETY INSPECTION	06/17/2021

Overlap Start Time	Overlap End Time	Overlap Submit Date
2:45PM	4:45PM	11/12/2019

Inspection determined facility to be in compliance with licensing rules.

Open Violations: 10

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 12

Total Children 51

Staff	Child	Class Age	Note
3	8	INFANTS AND TODDLERS	Tracy Arlotta (giving breaks) and Jessica Weisner; Rachel Orton (coming back from break) with children ages 1 to 2 years
2	7	INFANTS AND TODDLERS	Shawna Wilson and Samantha Harris with children ages 6 months to 1 year
2	8	MIXED	Angela Griffin and Natalie Lucas with children ages 2 to 3 years (This room is part of infant toddler unit with a variance to allow children over age 2 due to Head Start requirements)
2	0	NO CHILDREN IN ATTENDANCE	Carla Pelton (director) and Monica Roellig (cook) with no children
2	16	PRESCHOOL	Julie Scott and Makoce Bear Runner with children ages 3 to 5 years
1	12	SCHOOL AGE	Juanita Ziegler with children ages 5 to 11 years


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 Violation
19 CSR 30-62.090 Disaster and Emergency Preparedness Compliance
19 CSR 30-62.092 Furniture, Equipment and Materials Violation
19 CSR 30-62.102 Personnel Violation
19 CSR 30-62.112 Staff/Child Ratios Compliance
19 CSR 30-62.122 Medical Examination Reports Violation
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 Violation
19 CSR 30-62.202 Nutrition and Food Service Violation
19 CSR 30-62.212 Transportation and Field Trips Compliance
19 CSR 30-62.222 Records and Reports Violation
19 CSR 30-63.020 General Requirements Violation
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