MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

INSPECTION REPORT

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Facility Information

Facility Name

Facility DVN

Phone

Physical Address

Owner

Mailing Address

Provider/Director

E-mail Address

Incorporated

Child Care Specialist

Age Range

Capacity

Facility Type

Limitations

Inspection Information

Date

Arrival Time

Departure Time

Notice

Inspection Type

Inspection ID

Document	Document-Date
ANNUAL DECLARATION	11/01/2021
LICENSING ORIENTATION	06/11/2014
DISASTER AND EMERGENCY PREPAREDNESS PLAN	06/11/2014
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	11/01/2021
LOCAL FIRE DEPARTMENT NOTIFICATION	06/11/2014
SAFE SLEEP POLICY	06/11/2014
OWNER/PROVIDER REFERENCES	06/11/2014
SAMPLE WEEKLY MENU	06/11/2014
SAMPLE FORMS	06/11/2014
REGISTERING FICTITIOUS NAMES	06/11/2014
LOCAL BUILDING APPROVAL	06/11/2014
LOCAL ZONING APPROVAL	06/11/2014
LINES OF ADMINISTRATIVE AUTHORITY	06/11/2014
DAILY SCHEDULE	06/11/2014
CHILD CARE PRACTICES	06/11/2014
DISCIPLINE POLICIES	06/11/2014
DIAGRAM/OUTDOOR	06/11/2014
DIAGRAM/INDOOR	06/11/2014
DIRECTOR'S QUALIFICATIONS	07/02/2014
POLICIES	06/11/2014
STAFF SHEET	10/18/2018
EQUIPMENT LIST	11/01/2021
APPLICATION	10/18/2018
SANITATION INSPECTION	08/10/2021
FIRE/SAFETY INSPECTION	09/07/2021

Open Violations:

NOTE

The licensee is responsible for compliance with all licensing rules, including but not limited to the rules listed on this compliance report form.

Staff	Child	Class Age	Note
1	4	INFANTS AND TODDLERS	Maria Villarreal with 4 children 7-21 months of age.
2	11	MIXED	Cynthia and Daniel Raven with 11 children 2-5 years of age including 2 two-year-olds.


5 CSR 25-500.032 Organization and Administration Compliance
5 CSR 25-500.042 Licensing Process Compliance
5 CSR 25-500.052 Annual Requirements Compliance
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers Compliance
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 Compliance
5 CSR 25-500.102 Personnel Compliance
5 CSR 25-500.112 Staff/Child Ratios Compliance
5 CSR 25-500.122 Medical Examination Reports Compliance
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 Compliance
5 CSR 25-500.202 Nutrition and Food Service Compliance
5 CSR 25-500.212 Transportation and Field Trips Not Observed
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