MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
CANFIELD, BERDEINA JILL

Facility DVN
001807307

Phone
(417) 872-7279

Physical Address
1610 E JODY CIR
REPUBLIC
MO 65738-1259

Owner
CANFIELD, BERDEINA JILL

Mailing Address

Provider/Director
CANFIELD, BERDEINA JILL

E-mail Address
mamajill@hotmail.com

Incorporated

Child Care Specialist
BILLIE RUSSELL

Age Range
2 MONTHS - 12 YEARS

Capacity
6

Facility Type
FAMILY HOME

Limitations
IF ONLY 4 CHILDREN PRESENT, ALL CHILDREN MAY BE UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 6 CHILDREN IN CARE NO MORE THAN 3 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER

Inspection Information

Date
10/28/2021

Arrival Time
2:30 PM

Departure Time
3:24 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2411435630

Document	Document-Date
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	08/30/2021
ANNUAL DECLARATION	08/30/2021
SAMPLE WEEKLY MENU	09/18/2003
DIAGRAM/OUTDOOR	09/18/2003
DIAGRAM/INDOOR	09/18/2003
DAILY SCHEDULE	10/20/2003
CHILD CARE/DISCIPLINE POLICIES	07/28/2011
OWNER/PROVIDER REFERENCES	09/29/2003
ASSISTANT APPROVAL REQUEST	08/22/2013
ASSISTANT REFERENCES	08/10/2015
LOCAL FIRE DEPARTMENT NOTIFICATION	08/12/2015
SANITATION INSPECTION	09/10/2021
EQUIPMENT LIST	08/30/2021
FIRE/SAFETY INSPECTION	10/05/2021
APPLICATION	08/14/2019

Overlap Start Time	Overlap End Time	Overlap Submit Date
3:45PM	5:45PM	7/28/2011

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 1

Total Children 4

Staff	Child	Class Age	Note
1	4	MIXED	Provider, Jill Canfield, was with four (4) children ages; two (2) two (2) years old, one (1) 22 months old and one (1) nine (9) month old.


5 CSR 25-400.025 Organization and Administration Compliance
5 CSR 25-400.045 Licensing Process Compliance
5 CSR 25-400.055 Annual Requirements Compliance
5 CSR 25-400.085 Physical Requirements of the Family Day Care Home Compliance
5 CSR 25-400.086 Fire Safety Compliance
5 CSR 25-400.090 Disaster and Emergency Preparedness Compliance
5 CSR 25-400.095 Furniture, Equipment and Materials Compliance
5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel Compliance
5 CSR 25-400.115 Day Care Family and Household Compliance
5 CSR 25-400.125 Medical Examination Reports Compliance
5 CSR 25-400.135 Admission Policies and Procedures Compliance
5 CSR 25-400.145 Nighttime Care Compliance
5 CSR 25-400.155 Overlap Care of Children Not Observed
5 CSR 25-400.165 Emergency School Closings Not Observed
5 CSR 25-400.175 Child Care Program Compliance
5 CSR 25-400.185 Health Care Compliance
5 CSR 25-400.190 Nutrition and Food Service Not Observed
5 CSR 25-400.200 Transportation and Field Trips Compliance
5 CSR 25-400.210 Records and Reports Compliance
5 CSR 25-600.020 Background Screening Findings Compliance
5 CSR 25-600.040 General Requirements 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