DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

APPLE BLOSSOM LEARNING CENTER LLC

002813807

(417) 349-0063

1505A N MAIN ST
MOUNTAIN GROVE
MO  65711-1038

APPLE BLOSSOM LEARNING CENTER LLC



 

SMART, SHANNON DAWN

dsmart1304@hotmail.com


ELAINE S COX

BIRTH - 12 YEARS

28

GROUP HOME AND CENTER

5 CHILDREN UNDER 12 MONTHS; 8 CHILDREN UNDER 24 MONTHS
 
Inspection Information

11/15/2021

1:51 PM

3:34 PM

UNANNOUNCED

COMPLIANCE MONITORING

2411605058


DocumentDocument-Date
LINES OF ADMINISTRATIVE AUTHORITY 03/03/2020
JOB RESPONSIBILITIES 02/10/2020
SAMPLE WEEKLY MENU 02/10/2020
DISASTER AND EMERGENCY PREPAREDNESS PLAN 01/30/2020
POLICIES 02/10/2020
CHILD CARE PRACTICES 01/02/2020
CERTIFICATE OF GOOD STANDING 01/02/2020
SANITATION INSPECTION 12/15/2020
STAFF SHEET 01/02/2020
DISCIPLINE POLICIES 01/02/2020
SAMPLE FORMS 01/02/2020
LOCAL FIRE DEPARTMENT NOTIFICATION 01/02/2020
DIAGRAM/OUTDOOR 01/02/2020
DIAGRAM/INDOOR 01/02/2020
LLC ARTICLES OF ORGANIZATION 11/11/2019
DIRECTOR'S QUALIFICATIONS 03/23/2020
FIRE/SAFETY INSPECTION 01/21/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 05/20/2021
EQUIPMENT LIST 05/20/2021
ANNUAL DECLARATION 05/05/2021
DAILY SCHEDULE 01/23/2020
LLC OPERATING AGREEMENT 03/03/2020
LOCAL BUILDING APPROVAL 03/03/2020
LOCAL ZONING APPROVAL 03/03/2020

Overlap Start TimeOverlap End TimeOverlap Submit Date
  3:30PM   5:30PM   9/16/2021



Inspection determined facility to be in compliance with licensing rules.
Open Violations: 6
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 5
Total Children 14
StaffChildClass AgeNote
2 6 INFANTS AND TODDLERS Rita Barker and Mariah Adler with 6 children age 3 months to 21 months.
3 8 MIXED Shannon Smart, Kortnie Bunch and Stephanie Lane with 8 children age 2 years to 4 years, including 2-2 year old children.

 
5 CSR 25-500.032 Organization and Administration
Compliance
5 CSR 25-500.042 Licensing Process
Compliance
5 CSR 25-500.052 Annual Requirements
Not Observed
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers
Violation
 Provider Comments
Violation
The observed surface area under dome climber and west facing slide, from which a child might fall consists of bare soil.
Licensing Rule Reference
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (6) (A) 8. states: Concrete, asphalt, carpet, grass or bare soil is not an acceptable surface under outdoor equipment from which children might fall and be injured.
Correction Required
The facility shall not use concrete, asphalt, carpet, grass or bare soil under equipment from which a child might fall.

Correction Verification
Submit Documentation

Compliance Date

Violation
The requirements for protective outlet covers or twist-lock outlets were not met as evidenced by electrical outlets were not covered in that one electrical outlet uncovered in the small preschool room.
Licensing Rule Reference
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (G) states: Protective outlet covers or twist-lock outlets shall be used in areas accessible to the children.
Correction Required
The facility shall use outlet covers or twist-lock outlets as required.

Correction Verification
Corrected on Site

Compliance Date
11/15/2021
5 CSR 25-500.087 Fire Safety
Compliance
5 CSR 25-500.090 Disaster and Emergency Preparedness
Compliance
5 CSR 25-500.092 Furniture, Equipment and Materials
Violation
 Provider Comments
Violation
Stationary equipment, merry-go-round, was unsafe as evidenced by the equipment had exposed footings.
Licensing Rule Reference
5 CSR 25-500.092 Furniture, Equipment and Materials (3) (D) states: Stationary equipment such as swings, slides and climbers shall be securely anchored, have no exposed footings and be placed to avoid accidents or collisions.
Correction Required
Stationary equipment shall be safely installed, stable and securely anchored.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-500.102 Personnel
Violation
 Provider Comments
Violation
A facility orientation was not conducted for a caregiver(s) before being left alone with children. The following staff need a facility orientation: Mariah Adler and Stephanie Lane.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (1) (K) . states: The child care provider shall ensure that within seven (7) days of employment or volunteering and before being left alone with children that caregivers receive a facility orientation. The child care provider shall ensure that documentation verifying completion of the facility orientation is maintained and on file for review by the department for each caregiver. The facility orientation shall include:
Correction Required
The facility shall ensure that a facility orientation occurs within 7 days and documentation verifying completion is maintained and on file for review by the department for each caregiver.

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
Medical examination report(s) was/were not on file for Stephanie Lane as evidenced by a medical examination was not on file within 30 days of an individual beginning to work with children.
Licensing Rule Reference
5 CSR 25-500.122 Medical Examination Reports (1) (A) states: All persons working in a day care facility in any capacity during child care hours, including volunteers counted in staff/child ratios, shall be in good physical and emotional health with no physical or mental conditions which would interfere with child care responsibilities. These persons shall have a medical examination report, signed by a licensed physician or registered nurse who is under the supervision of a licensed physician, on file at the facility at the time of initial licensure or within thirty (30) days following employment.
Correction Required
Medical reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
A medical examination report did not include a completed Risk Assessment for Tuberculosis form for Stephanie Lane.
Licensing Rule Reference
5 CSR 25-500.122 Medical Examination Reports (1) (B) . states: Medical examination reports shall include a “Risk Assessment for Tuberculosis” form, included herein, completed and signed by a health care professional, as provided by the Missouri Department of Health and Senior Services (MDHSS). If the person has signs or symptoms of tuberculosis, or risk factors for tuberculosis, then testing for tuberculosis shall occur.
Correction Required
TB reports shall be on file as required

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-500.132 Admission Policies and Procedures
Compliance
5 CSR 25-500.142 Nighttime Care
Compliance
5 CSR 25-500.152 Hourly Care Facilities
Compliance
5 CSR 25-500.162 Overlap Care of Children
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
Violation
 Provider Comments
Violation
There was no parental written objection to immunizations on file for 1 child(ren).
Licensing Rule Reference
5 CSR 25-500.192 Health Care (4) (B) 2. B. states: A parent or guardian exemption, by which a child shall be exempted from immunization requirements if one (1) parent or guardian files a written objection to immunization with the day care administrator. Exemptions shall be accepted by the day care administrator when the necessary information as determined by the department is filed with the day care administrator by the parent or guardian. Exemption forms shall be provided by the department (see 19 CSR 40-61.185).
Correction Required
Child immunization requirements shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

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
Compliance
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