DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

CROCKER ACADEMY INC.

000467589

(573) 736-5922

324 S COMMERCIAL ST
CROCKER
MO  65452-9112

CROCKER ACADEMY INC.

PO BOX 222
CROCKER
MO  65452

ALLEN, KELI M

kelihelton@yahoo.com

Incorporated

SHELBY N KOETTING

24 MONTHS - 12 YEARS

40

GROUP HOME AND CENTER

 
Inspection Information

09/14/2021

9:00 AM

10:18 AM

UNANNOUNCED

COMPLIANCE MONITORING

2408324109


DocumentDocument-Date
DISCIPLINE POLICIES 08/14/2012
REGISTERING FICTITIOUS NAMES 06/14/2012
ARTICLES OF INCORPORATION 04/27/1992
LOCAL ZONING APPROVAL 08/14/1992
LINES OF ADMINISTRATIVE AUTHORITY 08/14/1992
JOB RESPONSIBILITIES 09/02/1992
SAMPLE FORMS 06/30/2008
CHILD CARE PRACTICES 08/14/1992
SAMPLE WEEKLY MENU 08/14/1992
DAILY SCHEDULE 08/14/1992
POLICIES 08/14/1992
DIAGRAM/OUTDOOR 08/14/1992
DIAGRAM/INDOOR 08/14/1992
APPLICATION 08/13/2020
STAFF SHEET 07/28/2020
EQUIPMENT LIST 05/11/2021
FIRE/SAFETY INSPECTION 06/02/2021
SANITATION INSPECTION 07/30/2021
DIRECTOR'S QUALIFICATIONS 09/19/2019
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 05/11/2021
ANNUAL DECLARATION 05/11/2021

Overlap Start TimeOverlap End TimeOverlap Submit Date
  3:00PM   5:00PM   6/8/2010



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 2
Total Children 15
StaffChildClass AgeNote
2 15 PRESCHOOL Keli Allen and Zoie Helton with 15 preschool children.

 
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 the main room was/were not in good condition as evidenced by chipping paint on the door frame leading to the bathrooms and storage room.
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

Violation
The walls located in the main room was/were not in good condition as evidenced by baseboard peeling off the wall along the ramp leading to the playground.
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
Compliance
19 CSR 30-62.112 Staff/Child Ratios
Compliance
19 CSR 30-62.122 Medical Examination Reports
Violation
 Provider Comments
Violation
The medical examination report and/or the school-age health report form(s) used was not supplied by the department or did not contain all the required information as evidenced by two children's medical examination reports did not include a signature from the evaluating physician, as required on the department supplied form.
Licensing Rule Reference
19 CSR 30-62.122 Medical Examination Reports (2) (E) states: The medical examination report form and the health history report for school-age children shall be supplied by the department or the facility may use its own form if it contains all the information on the department's form.
Correction Required
Child medical requirements shall be completed and 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
One child(ren) records did not include full name, home address, employers name and address, work schedule and home and work telephone numbers of the 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
Corrected on Site

Compliance Date
9/14/2021
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