DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT
Facility Information

JACKSON, MILDRED MARIE

000645350

(573) 719-3410

2122 SPRUCE ST
HANNIBAL
MO  63401-3850

JACKSON, MILDRED MARIE



 

JACKSON, MILDRED MARIE

srradmin@douglassonline.org


BETHANY C DUCKWORTH

6 WEEKS - 12 YEARS

10

FAMILY HOME

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

08/20/2021

9:58 AM

10:20 AM

UNANNOUNCED

REINSPECTION

2406794267


DocumentDocument-Date
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 09/01/2020
SAFETY PLAN 08/26/2020
ASSISTANT APPROVAL REQUEST 09/08/2020
APPLICATION 09/01/2020
EQUIPMENT LIST 08/26/2020
SANITATION INSPECTION 06/04/2021
FIRE/SAFETY INSPECTION 07/19/2021
OWNER/PROVIDER REFERENCES 09/01/1994
DAILY SCHEDULE 07/29/1994
SAMPLE WEEKLY MENU 07/29/1994
CHILD CARE/DISCIPLINE POLICIES 09/15/1994
POLICIES 09/15/1994
SAFE SLEEP POLICY 03/01/2016
DIAGRAM/INDOOR 03/31/2010
DIAGRAM/OUTDOOR 07/23/2008
DISASTER AND EMERGENCY PREPAREDNESS PLAN 02/10/2020




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 4
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 6
StaffChildClass AgeNote
1 6 MIXED Staff: Mildred Jackson. Age range 20 months through 8 years. One child under 2 years old.
1 0 NO CHILDREN IN ATTENDANCE Tyrese Williams, age 19, who lives in the home with Mildred., was also present during re-inspection.

 
19 CSR 30-61.025 Organization and Administration
Not Observed
19 CSR 30-61.045 Licensing Process
Not Observed
19 CSR 30-61.055 Annual Requirements
Not Observed
19 CSR 30-61.085 Physical Requirements of the Family Day Care Home
Not Observed
19 CSR 30-61.086 Fire Safety
Not Observed
19 CSR 30-61.090 Disaster and Emergency Preparedness
Not Observed
19 CSR 30-61.095 Furniture, Equipment and Materials
Not Observed
19 CSR 30-61.105 The Child Care Provider and Other Child Care Personnel
Not Observed
19 CSR 30-61.115 Day Care Family and Household
Not Observed
19 CSR 30-61.125 Medical Examination Reports
Violation
 Provider Comments
Violation
Requirements for infant-toddler/preschool child medical examination reports on file were not met as evidenced by there was no medical examination report on file within 30 days of admission - the admission date(s) was/were approximately 8-1-2020.
Licensing Rule Reference
19 CSR 30-61.125 Medical Examination Reports (2) (A) states: The provider shall require, within thirty (30) days following the admission of each infant, toddler or preschool child, a medical examination report signed by a licensed physician or registered nurse who is under the supervision of licensed physician and completed not more than twelve (12) months prior to admission.
Correction Required
Child medical requirements shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-61.135 Admission Policies and Procedures
Not Observed
19 CSR 30-61.145 Nighttime Care
Not Observed
19 CSR 30-61.155 Overlap Care of Children
Not Observed
19 CSR 30-61.165 Emergency School Closings
Not Observed
19 CSR 30-61.175 Child Care Program
Not Observed
19 CSR 30-61.185 Health Care
Not Observed
19 CSR 30-61.190 Nutrition and Food Service
Not Observed
19 CSR 30-61.200 Transportation and Field Trips
Not Observed
19 CSR 30-61.210 Records and Reports
Violation
 Provider Comments
Violation
A copy of qualifying background screening results was/were not kept on file for: Tyrese Williams (household member).
Licensing Rule Reference
19 CSR 30-61.210 Records and Reports (9) states: A copy of qualifying background screening results shall be kept on file for child care staff members, as required by 19 CSR 30-63.020 General Requirements.
Correction Required
The child care provider shall keep on file a copy of qualifying background screening results for child care staff member(s).

Correction Verification
Submit Documentation

Compliance Date

Violation
Records were not available for inspection by the department upon request as evidenced by no information was available for Tyrese Williams.
Licensing Rule Reference
19 CSR 30-61.210 Records and Reports (11) states: All records shall be available in the home for inspection by the department upon request.
Correction Required
All required records shall be kept on file at the facility and accessible at all time.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-63.020 General Requirements
Violation
 Provider Comments
Violation
Criminal background check results were not on file for Tyrese Williams (household member).
Licensing Rule Reference
19 CSR 30-63.020 General Requirements (1) states: Prior to the employment or presence of a child care staff member in a family child care home, group child care home, child care center, or license-exempt facility not exempted by section 210.1080.13, RSMo, the child care provider shall request the results of a criminal background check for such child care staff member from the department.
Correction Required
Required results of criminal background checks shall be on file.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-63.040 Background Screening Findings
Not Observed
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.
Not Observed
RSMo 210.211.  License required - exceptions - written notice of licensure status, when.
Not Observed
RSMo 210.252. Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized.
Compliance