DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

CLEVER RV SCHOOL DISTRICT

001355966

(417) 743-4810

103 S PUBLIC AVE
CLEVER
MO  65631-9103

CLEVER RV SCHOOL DISTRICT



 

HARVEY, PAULA SUE

harveyp@cleverbluejays.org


ANGEL DONSON

36 MONTHS - 5 YEARS

40

GROUP HOME AND CENTER

 
Inspection Information

01/07/2022

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2415925801


DocumentDocument-Date
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 11/18/2021
EQUIPMENT LIST 11/11/2021
APPLICATION 02/05/2020
STAFF SHEET 02/14/2020
LINES OF ADMINISTRATIVE AUTHORITY 02/18/2000
DIRECTOR'S QUALIFICATIONS 04/03/2007
CHILD CARE PRACTICES 02/07/2000
SAMPLE WEEKLY MENU 02/18/2000
DAILY SCHEDULE 02/07/2000
POLICIES 02/18/2000
DIAGRAM/OUTDOOR 03/24/2000
DIAGRAM/INDOOR 03/24/2000
LOCAL ZONING APPROVAL 03/24/2000
LOCAL BUILDING APPROVAL 03/24/2000
DISCIPLINE POLICIES 02/07/2000
DISASTER AND EMERGENCY PREPAREDNESS PLAN 03/14/2018
SANITATION INSPECTION 12/10/2020
ANNUAL DECLARATION 03/10/2021




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.

 
5 CSR 25-500.032 Organization and Administration
Compliance
5 CSR 25-500.042 Licensing Process
Compliance
5 CSR 25-500.052 Annual Requirements
Violation
 Provider Comments
Violation
The annual fire safety inspection was not approved.
Licensing Rule Reference
5 CSR 25-500.052 Annual Requirements (2) (A) states: Evidence of compliance with a fire and safety inspection as conducted by the State Fire Marshal or his/her designee.
Correction Required
The facility shall submit evidence of compliance with annual fire safety requirements.

Correction Verification
Submit Documentation

Compliance Date
12/7/2021
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
Violation
 Provider Comments
Violation
A medical examination report did not include a completed Risk Assessment for Tuberculosis form for Maria Hedgpeth and Sheila Newman.
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
12/17/2021
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
Compliance
5 CSR 25-500.222 Records and Reports
Violation
 Provider Comments
Violation
Records were not available for inspection by the department upon request as evidenced by Staff files were not available for review.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (11) states: All records shall be available in the facility for inspection by the department upon request.
Correction Required
Records shall be available at the facility for inspection.

Correction Verification
Submit Documentation

Compliance Date
11/18/2021
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