MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
CULBERTSON, SHERRY A

Facility DVN
000429549

Phone
(573) 222-6268

Physical Address
4063 COUNTY ROAD 290
PUXICO
MO 63960-8216

Owner
CULBERTSON, SHERRY A

Mailing Address

Provider/Director
CULBERTSON, SHERRY A

E-mail Address
sculbertson56@yahoo.com

Incorporated

Child Care Specialist
SAMINA C HISE

Age Range
12 MONTHS - 12 YEARS

Capacity
10

Facility Type
FAMILY HOME

Limitations
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; IF ONLY 4 CHILDREN PRESENT, ALL CHILDREN MAY BE UNDER AGE 2 WITH 1 ADULT CAREGIVER

Inspection Information

Date
10/05/2021

Arrival Time
8:20 AM

Departure Time
9:00 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2409793384

Document	Document-Date
DIAGRAM/INDOOR	04/03/1991
DIAGRAM/OUTDOOR	04/03/1991
POLICIES	10/14/2004
SAMPLE WEEKLY MENU	01/31/1992
CHILD CARE/DISCIPLINE POLICIES	10/14/2004
OWNER/PROVIDER REFERENCES	04/15/1991
ASSISTANT APPROVAL REQUEST	03/31/2017
ASSISTANT REFERENCES	03/31/2017
DAILY SCHEDULE	01/31/1992
DISASTER AND EMERGENCY PREPAREDNESS PLAN	03/22/2012
APPLICATION	02/04/2019
FIRE/SAFETY INSPECTION	02/08/2021
SANITATION INSPECTION	02/23/2021
ANNUAL DECLARATION	04/07/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	04/07/2021
EQUIPMENT LIST	04/07/2021

Inspection determined facility to be in compliance with licensing rules.

Open Violations: 5

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 1

Total Children 10

Staff	Child	Class Age	Note
1	10	MIXED	Provider Sherry Culbertson with ten children aged 2 to 5. Two children are two. No children are under two.


19 CSR 30-61.025 Organization and Administration Compliance
19 CSR 30-61.045 Licensing Process Compliance
19 CSR 30-61.055 Annual Requirements Compliance
19 CSR 30-61.085 Physical Requirements of the Family Day Care Home Violation
19 CSR 30-61.086 Fire Safety Compliance
19 CSR 30-61.090 Disaster and Emergency Preparedness Compliance
19 CSR 30-61.095 Furniture, Equipment and Materials Compliance
19 CSR 30-61.105 The Child Care Provider and Other Child Care Personnel Compliance
19 CSR 30-61.115 Day Care Family and Household Compliance
19 CSR 30-61.125 Medical Examination Reports Violation
19 CSR 30-61.135 Admission Policies and Procedures Compliance
19 CSR 30-61.145 Nighttime Care Compliance
19 CSR 30-61.155 Overlap Care of Children Compliance
19 CSR 30-61.165 Emergency School Closings Compliance
19 CSR 30-61.175 Child Care Program Compliance
19 CSR 30-61.185 Health Care Compliance
19 CSR 30-61.190 Nutrition and Food Service Compliance
19 CSR 30-61.200 Transportation and Field Trips Compliance
19 CSR 30-61.210 Records and Reports Compliance
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
RSMo 210.252. Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized. Compliance