MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT

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Facility Information

Facility Name
GRACE LUTHERAN CHURCH, HOLTS SUMMIT MO

Facility DVN
002351753

Phone
(573) 896-8824

Physical Address
618 HALIFAX RD
HOLTS SUMMIT
MO 65043

Owner
GRACE LUTHERAN CHURCH, HOLTS SUMMIT MO

Mailing Address

Provider/Director
DIENER, MICHAEL J

E-mail Address
revmjdiener@gmail.com

Incorporated
Incorporated

Child Care Specialist
JIM PARSLEY

Age Range
24 MONTHS - 10 YEARS

Capacity
40

Facility Type
GROUP HOME AND CENTER

Limitations

Inspection Information

Date
09/20/2021

Arrival Time
9:30 AM

Departure Time
10:47 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2408666887

Document	Document-Date
LICENSING ORIENTATION	08/24/2012
ANNUAL DECLARATION	07/27/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	07/27/2021
DIRECTOR'S QUALIFICATIONS	09/12/2012
LINES OF ADMINISTRATIVE AUTHORITY	08/24/2012
JOB RESPONSIBILITIES	08/24/2012
CERTIFICATE OF GOOD STANDING	05/07/2011
ARTICLES OF INCORPORATION	08/24/2012
CHILD CARE PRACTICES	08/24/2012
DAILY SCHEDULE	08/24/2012
POLICIES	08/24/2012
DIAGRAM/OUTDOOR	07/15/2013
DIAGRAM/INDOOR	07/15/2013
SAMPLE WEEKLY MENU	01/13/2014
SANITATION INSPECTION	05/04/2021
FIRE/SAFETY INSPECTION	06/14/2021
STAFF SHEET	08/05/2020
EQUIPMENT LIST	07/16/2021
APPLICATION	08/05/2020
DISASTER AND EMERGENCY PREPAREDNESS PLAN	05/07/2011
DISCIPLINE POLICIES	05/07/2011
LOCAL BUILDING APPROVAL	05/07/2011
LOCAL FIRE DEPARTMENT NOTIFICATION	05/07/2011
LOCAL ZONING APPROVAL	05/07/2011
SAMPLE FORMS	05/07/2011

Inspection determined facility to be in compliance with licensing rules.

Open Violations: NA

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 3

Total Children 14

Staff	Child	Class Age	Note
2	14	MIXED	There were 14 children 2-5 years of age in care including 6 two-year-olds being supervised by Mary Nichols and Tessa Wilson.
1	0	NO CHILDREN IN ATTENDANCE	Director, Michael Diener, also present.


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 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 Compliance
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 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