DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

INDEPENDENCE 30 SCHOOL DISTRICT

002301084

(816) 521-5468

15208 E 39TH ST S
INDEPENDENCE
MO  64055-4239

INDEPENDENCE 30 SCHOOL DISTRICT

201 N FOREST AVE
INDEPENDENCE
MO  64050-2513

MASTERS, REBEKAH LEA

YOUTH_DEVELOPMENT@ISDSCHOOLS.ORG


BEN NEWTON

5 YEARS - 11 YEARS

130

SCHOOL AGE

 
Inspection Information

10/19/2021

8:15 AM

9:26 AM

UNANNOUNCED

COMPLIANCE MONITORING

2410661646


DocumentDocument-Date
LINES OF ADMINISTRATIVE AUTHORITY 10/17/2011
DIRECTOR'S JOB RESPONSIBILITIES 10/17/2011
DAILY SCHEDULE 10/17/2011
CHILD CARE PRACTICES 06/17/2013
DISCIPLINE POLICIES 10/17/2011
POLICIES 10/17/2011
JOB RESPONSIBILITIES 10/17/2011
DIRECTOR'S QUALIFICATIONS 09/29/2011
SAMPLE WEEKLY MENU 10/17/2011
SAMPLE FORMS 10/17/2011
DIAGRAM/OUTDOOR 07/06/2011
DIAGRAM/INDOOR 07/06/2011
APPLICATION 08/01/2019
EQUIPMENT LIST 08/08/2021
STAFF SHEET 08/22/2019
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 08/19/2021
ANNUAL DECLARATION 08/19/2021




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 3
Total Children 33
StaffChildClass AgeNote
2 17 SCHOOL AGE Director Rebekah Masters and caregiver Shelby Latrell were present with seventeen (17) children, all school age.
1 16 SCHOOL AGE Caregiver Ainsley Scott was present with sixteen children, all school age.

 
5 CSR 25-500.032 Organization and Administration
Compliance
5 CSR 25-500.042 Licensing Process
Compliance
5 CSR 25-500.052 Annual Requirements
Compliance
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers
Compliance
5 CSR 25-500.090 Disaster and Emergency Preparedness
Compliance
5 CSR 25-500.092 Furniture, Equipment and Materials
Compliance
5 CSR 25-500.102 Personnel
Violation
 Provider Comments
Violation
The facility did not conduct a Family Care Safety Registry screening for Rebekah Masters, Martha Johnson, and Ainsley Scott, who was hired on 9/3/2014, 7/30/2019, and 1/29/2020, respectively.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (1) (P) states: The child care provider shall conduct a Family Care Safety Registry screening prior to employment for any newly hired child care staff member who has a qualifying criminal background check result.
Correction Required
Required results of the Family Care Safety Registry screening shall be on file.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-500.112 Staff/Child Ratios
Compliance
5 CSR 25-500.122 Medical Examination Reports
Violation
 Provider Comments
Violation
A school-age health report form(s) used was not supplied by the department or did not contain all the required information as evidenced by absence of school-age health report for Child C.
Licensing Rule Reference
5 CSR 25-500.122 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

5 CSR 25-500.132 Admission Policies and Procedures
Compliance
5 CSR 25-500.172 Emergency School Closings
Compliance
5 CSR 25-500.182 Child Care Program
Compliance
5 CSR 25-500.192 Health Care
Compliance
5 CSR 25-500.202 Nutrition and Food Service
Compliance
5 CSR 25-500.212 Transportation and Field Trips
Compliance
5 CSR 25-500.222 Records and Reports
Violation
 Provider Comments
Violation
Child A, Child F, Child G, Child H, Child I, Child K child(ren) records did not include telephone number of family physician or hospital.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (D) states: Name and phone number of the family physician, hospital, or both, to be used in an emergency;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-600.020 General Requirements
Compliance
5 CSR 25-600.040 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