DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

DOUGLASS COMMUNITY SERVICES, INCORPORATED

000672599

(573) 221-1540

661 CLINIC RD
HANNIBAL
MO  63401-3607

DOUGLASS COMMUNITY SERVICES, INCORPORATED

661 CLINIC RD
HANNIBAL
MO  63401-3607

CAPP, ANNA LEE

EHSCLINIC@DOUGLASSONLINE.ORG

Incorporated

BETHANY C DUCKWORTH

6 WEEKS - 35 MONTHS

16

GROUP HOME AND CENTER

 
Inspection Information

10/19/2021

10:21 AM

11:29 AM

UNANNOUNCED

COMPLIANCE MONITORING

2410192472


DocumentDocument-Date
ARTICLES OF INCORPORATION 06/02/2016
APPLICATION 08/25/2020
EQUIPMENT LIST 08/31/2021
CERTIFICATE OF GOOD STANDING 08/25/2020
STAFF SHEET 08/27/2020
FIRE/SAFETY INSPECTION 07/21/2020
SANITATION INSPECTION 06/01/2021
DIAGRAM/INDOOR 09/10/2002
DIAGRAM/OUTDOOR 09/10/2002
SAFE SLEEP POLICY 12/11/2015
LINES OF ADMINISTRATIVE AUTHORITY 04/27/2009
JOB RESPONSIBILITIES 06/15/2005
CHILD CARE PRACTICES 06/15/2005
POLICIES 06/15/2005
SAMPLE WEEKLY MENU 08/28/2001
SAMPLE FORMS 08/28/2001
DAILY SCHEDULE 08/28/2001
OWNER/PROVIDER REFERENCES 07/05/2001
DISCIPLINE POLICIES 03/03/2010
LLC ARTICLES OF ORGANIZATION 05/24/1993
DISASTER AND EMERGENCY PREPAREDNESS PLAN 08/06/2019
LOCAL ZONING APPROVAL 08/28/2008
DIRECTOR'S QUALIFICATIONS 01/30/2020
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 08/31/2021
ANNUAL DECLARATION 08/31/2021




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 8
Total Children 13
StaffChildClass AgeNote
3 7 MIXED Staff: Mary Brown, Jean Dunaway, and Sharea Salmon. Age range 17 months through 2 years old. Four 2 year old children.
3 6 MIXED Staff: Tammy Brown, Samantha Ibbeson and Alexis Keesey. Age range 5 months through 2 years. Five 2 year olds.
1 0 NO CHILDREN IN ATTENDANCE Staff: Anna Capp. Director.
1 0 NO CHILDREN IN ATTENDANCE Staff: Kathy Couch. Cook

 
19 CSR 30-62.032 Organization and Administration
Compliance
19 CSR 30-62.042 Licensing Process
Compliance
19 CSR 30-62.052 Annual Requirements
Violation
 Provider Comments
Violation
The annual fire safety inspection was not approved.
Licensing Rule Reference
19 CSR 30-62.052 Annual Requirements (2) (A) states: Evidence of compliance with a fire and safety inspection as conducted by the State Fire Marshal or his/her designee.
Correction Required
The facility shall submit evidence of compliance with annual fire safety requirements.

Correction Verification
Submit Documentation

Compliance Date

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
Violation
 Provider Comments
Violation
Child's medical examination report did not contain evidence that child’s current health is satisfactory for participation in a day care program.
Licensing Rule Reference
19 CSR 30-62.122 Medical Examination Reports (2) (B) states: The examination report shall determine if a child's medical history and current state of health is satisfactory participation in a day care program.
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
Violation
 Provider Comments
Violation
Requirements for immunization reports on file were not met as evidenced by a statement, certificate or record from a physician or other recognized health facility or personnel was not on file for one child(ren).
Licensing Rule Reference
19 CSR 30-62.192 Health Care (4) (A) states: No child shall be permitted to enroll in or attend any day care facility caring for ten (10) or more children unless the child has been immunized adequately against vaccine preventable childhood illnesses specified by the department in accordance with recommendations of the Immunization Practices Advisory Committee (ACIP). The parent or guardian of the child shall provide satisfactory evidence of the required immunizations. Satisfactory evidence means a statement, certificate or record from a physician or other recognized health facility or personnel, stating that the required immunizations have been given to the child and verifying the type of vaccine and the month, day and year of administration.
Correction Required
Child immunization requirements shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

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