MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
HALL, JACKIE MYRTLE

Facility DVN
000496557

Phone
(417) 924-8338

Physical Address
2320 HIGHWAY 5
MANSFIELD
MO 65704-8303

Owner
HALL, JACKIE MYRTLE

Mailing Address

Provider/Director
HALL, JACKIE MYRTLE

E-mail Address
jackiehall@centurytel.net

Incorporated

Child Care Specialist
ELAINE S COX

Age Range
BIRTH - 12 YEARS

Capacity
10

Facility Type
FAMILY HOME

Limitations
UP TO 10 CHILDREN IN CARE NO MORE THAN 2 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 10 CHILDREN IN CARE NO MORE THAN 4 CHILDREN UNDER AGE 2 WITH 2 ADULT CAREGIVERS; UP TO 6 CHILDREN IN CARE NO MORE THAN 3 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER; IF ONLY 4 CHILDREN PRESENT, ALL CHILDREN MAY BE UNDER AGE 2 WITH 1 ADULT CAREGIVER

Inspection Information

Date
12/14/2021

Arrival Time
2:40 PM

Departure Time
3:21 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2414332999

Document	Document-Date
ANNUAL DECLARATION	09/16/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	09/16/2021
EQUIPMENT LIST	09/16/2021
FIRE/SAFETY INSPECTION	08/23/2021
DAILY SCHEDULE	03/03/1997
ASSISTANT REFERENCES	08/27/2012
OWNER/PROVIDER REFERENCES	08/13/1996
SAMPLE WEEKLY MENU	08/27/1996
DIAGRAM/OUTDOOR	07/19/1996
DIAGRAM/INDOOR	07/19/1996
ASSISTANT APPROVAL REQUEST	08/27/1996
CHILD CARE/DISCIPLINE POLICIES	09/06/2002
POLICIES	09/06/2002
LOCAL FIRE DEPARTMENT NOTIFICATION	02/13/2018
SAFE SLEEP POLICY	02/13/2018
DISASTER AND EMERGENCY PREPAREDNESS PLAN	02/07/2018
SANITATION INSPECTION	09/28/2021

Overlap Start Time	Overlap End Time	Overlap Submit Date
3:40PM	3:55PM	7/30/2012
7:00AM	7:45AM	7/30/2012

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 2

Total Children 10

Staff	Child	Class Age	Note
2	10	MIXED	Dona Rippee, and Jackie Hall with 10 children ages 4 months to 4 years, including 3 children under the age of 2 years.


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 Compliance
5 CSR 25-400.165 Emergency School Closings Compliance
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 Compliance
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