MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
GOODALL, TIFFANY RAE

Facility DVN
002793366

Phone
(417) 546-8581

Physical Address
174 PLYMOUTH RD
FORSYTH
MO 65653-5165

Owner
GOODALL, TIFFANY RAE

Mailing Address
275 BARBS LN
FORSYTH
MO 65653-5327

Provider/Director
GOODALL, TIFFANY RAE

E-mail Address
trgoodall2015@gmail.com

Incorporated

Child Care Specialist
BILLIE RUSSELL

Age Range
BIRTH - 10 YEARS

Capacity
10

Facility Type
FAMILY HOME

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

Inspection Information

Date
12/15/2021

Arrival Time
12:30 PM

Departure Time
1:08 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2414472801

Document	Document-Date
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	12/15/2021
ANNUAL DECLARATION	12/15/2021
APPLICATION	09/12/2019
CHILD CARE/DISCIPLINE POLICIES	11/14/2019
DAILY SCHEDULE	11/14/2019
DIAGRAM/INDOOR	11/14/2019
DIAGRAM/OUTDOOR	11/14/2019
EQUIPMENT LIST	12/15/2021
POLICIES	11/14/2019
SAMPLE WEEKLY MENU	11/14/2019
FIRE/SAFETY INSPECTION	09/08/2021
SANITATION INSPECTION	09/23/2021
SAFE SLEEP POLICY	11/14/2019
ASSISTANT APPROVAL REQUEST	11/14/2019
DISASTER AND EMERGENCY PREPAREDNESS PLAN	11/19/2019

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.

Attendance at Time of Inspection

Total Staff 1

Total Children 7

Staff	Child	Class Age	Note
1	7	MIXED	Caregiver, Tiffany Goodall, was with one (1) child under two (2) and two (2) to five (5) year old children.


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