MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT

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Facility Information

Facility Name
KIDS VILLAGE WEST LLC

Facility DVN
002471034

Phone
(573) 860-2900

Physical Address
36 TAYLOR ST
SULLIVAN
MO 63080-1934

Owner
KIDS VILLAGE WEST LLC

Mailing Address

Provider/Director
PELTON, CARLA SUE

E-mail Address
kidsvillagewest@att.net

Incorporated

Child Care Specialist
REGINA WATKINS

Age Range
BIRTH - 12 YEARS

Capacity
63

Facility Type
GROUP HOME AND CENTER

Limitations
24 CHILDREN IN THE INFANT/TODDLER UNIT; 8 CHILDREN UNDER 12 MONTHS

Inspection Information

Date
11/15/2021

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2411374623

Document	Document-Date
ANNUAL DECLARATION	08/19/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	08/19/2021
SAMPLE FORMS	07/21/2014
CHILD CARE PRACTICES	05/19/2014
DISCIPLINE POLICIES	05/19/2014
POLICIES	07/21/2014
SAMPLE WEEKLY MENU	06/20/2014
DAILY SCHEDULE	07/21/2014
JOB RESPONSIBILITIES	08/06/2014
LINES OF ADMINISTRATIVE AUTHORITY	05/19/2014
LOCAL BUILDING APPROVAL	08/19/2021
LOCAL ZONING APPROVAL	08/19/2021
LLC ARTICLES OF ORGANIZATION	08/06/2014
LLC OPERATING AGREEMENT	08/06/2014
EQUIPMENT LIST	08/19/2021
STAFF SHEET	06/08/2018
SAFE SLEEP POLICY	06/28/2018
DISASTER AND EMERGENCY PREPAREDNESS PLAN	07/31/2018
FIRE/SAFETY INSPECTION	06/17/2021
SANITATION INSPECTION	05/03/2021
DIRECTOR'S QUALIFICATIONS	03/14/2019
DIAGRAM/OUTDOOR	10/13/2018
DIAGRAM/INDOOR	10/13/2018
APPLICATION	06/22/2020
CERTIFICATE OF GOOD STANDING	08/19/2021

Overlap Start Time	Overlap End Time	Overlap Submit Date
2:45PM	4:45PM	11/12/2019

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.