DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

SHALOM CHRISTIAN ACADEMY & DAYCARE

001802053

(573) 256-4824

312 RIDGEWAY AVE
COLUMBIA
MO  65203-2624

SHALOM CHRISTIAN ACADEMY & DAYCARE

PO BOX 901
COLUMBIA
MO  65205-0901

FONVILLE, ELAINE

Sca6903@mediacombb.net

Incorporated

JOY LYNN NICHOLS

BIRTH - 12 YEARS

48

GROUP HOME AND CENTER

18 CHILDREN UNDER 24 MONTHS
 
Inspection Information

01/13/2022

11:40 AM

12:52 PM

UNANNOUNCED

SUPPLEMENTAL

2416036625


DocumentDocument-Date
DIRECTOR'S QUALIFICATIONS 02/02/2016
JOB RESPONSIBILITIES 02/02/2016
LOCAL FIRE DEPARTMENT NOTIFICATION 02/02/2016
LOCAL ZONING APPROVAL 02/02/2016
LOCAL BUILDING APPROVAL 02/02/2016
SAMPLE WEEKLY MENU 02/02/2016
DISCIPLINE POLICIES 02/02/2016
ARTICLES OF INCORPORATION 01/11/2016
CERTIFICATE OF GOOD STANDING 01/11/2016
STAFF SHEET 01/11/2016
LINES OF ADMINISTRATIVE AUTHORITY 01/11/2016
DAILY SCHEDULE 02/02/2016
DIAGRAM/INDOOR 07/06/2015
DIAGRAM/OUTDOOR 07/06/2015
CHILD CARE PRACTICES 02/03/2016
POLICIES 02/03/2016
FIRE/SAFETY INSPECTION 12/06/2018
APPLICATION 11/17/2019
EQUIPMENT LIST 12/11/2019
SANITATION INSPECTION 11/07/2019

Overlap Start TimeOverlap End TimeOverlap Submit Date
  1:30PM   3:30PM   5/25/2016



Inspection determined facility to be in compliance with licensing rules.
Compliance Licensing Rules
Open Violations: 13
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 4
Total Children 17
StaffChildClass AgeNote
2 7 INFANTS AND TODDLERS children ages 9 months to 22 months; Elaine Fonville and Arianna Sutherin
1 10 MIXED 1 child age two; 9 children ages three and four; Marilyn Cook
1 0 NO CHILDREN IN ATTENDANCE John Fonville, facility owner

Compliance List
5 CSR 25-500.032 Organization and Administration
Not Observed
5 CSR 25-500.042 Licensing Process
Not Observed
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 premises were not safe and suitable as evidenced by no barriers in place in parking lot to prevent collisions with the building.
Licensing Rule Reference
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (A) states: The premises shall be safe and suitable for the care of children.
Correction Required
The premises shall be safe and suitable for the care of children.

Correction Verification
Submit Documentation

Compliance Date

Violation
The walls located in the I/T room, preschool room, and school age room was/were not in good condition as evidenced by the walls have chipping paint.
Licensing Rule Reference
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (2) (A) 6. states: Walls, ceilings and floors shall be finished with material which can be cleaned easily and shall be free of splinters, cracks and chipping paint. Floor covering shall be in good condition. Lead-free paint shall be used for all painted surfaces.
Correction Required
Walls, ceilings, and floors shall be made of approved materials, easily cleaned and in good condition.

Correction Verification
Submit Documentation

Compliance Date

Violation
The fall-zone area under and around outdoor equipment where children might fall and be injured was not covered with impact-absorbing materials to cushion a fall as evidenced by resilient material was not uniformly spread over the fall-zone area.
Licensing Rule Reference
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (6) (A) 7. states: Areas under and around outdoor equipment shall have continuous maintenance to ensure that the material remains in place and retains its cushioning properties. The resilient material shall be supplemented immediately or replaced as needed.
Correction Required
The facility shall maintain approved resilient material in all fall-zone areas.

Correction Verification
Submit Documentation

Compliance Date

Violation
The walls located in John's office was/were not in good condition as evidenced by the walls had cracks from being pushed in by a vehicle and the window was separated from the wall.
Licensing Rule Reference
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (2) (A) 6. states: Walls, ceilings and floors shall be finished with material which can be cleaned easily and shall be free of splinters, cracks and chipping paint. Floor covering shall be in good condition. Lead-free paint shall be used for all painted surfaces.
Correction Required
Walls, ceilings, and floors shall be made of approved materials, easily cleaned and in good condition.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-500.087 Fire Safety
Not Observed
5 CSR 25-500.090 Disaster and Emergency Preparedness
Not Observed
5 CSR 25-500.092 Furniture, Equipment and Materials
Not Observed
5 CSR 25-500.102 Personnel
Violation
 Provider Comments
Violation
Verification of safe sleep training was not documented and maintained as evidenced by Hailey Gomez, Mary Goodwater, Marilyn Cook, and Corizma Blair had no documentation of taking the training.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (4) (A) states: The training shall be documented and maintained as described in paragraph (3)(F)2. of this rule.
Correction Required
Safe sleep training shall be documented and maintained.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-500.112 Staff/Child Ratios
Not Observed
5 CSR 25-500.122 Medical Examination Reports
Violation
 Provider Comments
Violation
Medical examination report(s) was/were not on file for Hailey Gomez, Mary Goodwater, Marilyn Cook, and Corizma Blair 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 Hailey Gomez, Mary Goodwater, Marilyn Cook, and Corizma Blair.
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
Not Observed
5 CSR 25-500.142 Nighttime Care
Not Observed
5 CSR 25-500.152 Hourly Care Facilities
Not Observed
5 CSR 25-500.162 Overlap Care of Children
Not Observed
5 CSR 25-500.172 Emergency School Closings
Not Observed
5 CSR 25-500.182 Child Care Program
Not Observed
5 CSR 25-500.192 Health Care
Violation
 Provider Comments
Violation
The requirements for administering medication were not met as follows: medication was given to a child without the length of time the medication may be given specified.
Licensing Rule Reference
5 CSR 25-500.192 Health Care (3) (B) states: All medication shall be given to a child only with the dated, written permission of the parent(s) stating the length of time medication may be given.
Correction Required
All medication shall be administered and recorded as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The requirements for administering medication were not met as follows: medication was given to a child without dated permission.
Licensing Rule Reference
5 CSR 25-500.192 Health Care (3) (B) states: All medication shall be given to a child only with the dated, written permission of the parent(s) stating the length of time medication may be given.
Correction Required
All medication shall be administered and recorded as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The requirements for administering medication were not met as follows: medication was given to a child without written permission.
Licensing Rule Reference
5 CSR 25-500.192 Health Care (3) (B) states: All medication shall be given to a child only with the dated, written permission of the parent(s) stating the length of time medication may be given.
Correction Required
All medication shall be administered and recorded as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The requirements for administering medication were not met as follows: medication was available for administering to a child, however there was no written permission on file.
Licensing Rule Reference
5 CSR 25-500.192 Health Care (3) (B) states: All medication shall be given to a child only with the dated, written permission of the parent(s) stating the length of time medication may be given.
Correction Required
All medication shall be administered and recorded as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
Requirements for immunization reports on file were not met as evidenced by required immunizations verifying the type of vaccine and the month, day and year of administration was not on file for 2 child(ren).
Licensing Rule Reference
5 CSR 25-500.192 Health Care (4) (A) states: No child shall be permitted to enroll in or attend any day care facility caring for ten (10) or more children unless the child has been immunized adequately against vaccine preventable childhood illnesses specified by the department in accordance with recommendations of the Immunization Practices Advisory Committee (ACIP). The parent or guardian of the child shall provide satisfactory evidence of the required immunizations. Satisfactory evidence means a statement, certificate or record from a physician or other recognized health facility or personnel, stating that the required immunizations have been given to the child and verifying the type of vaccine and the month, day and year of administration.
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
Not Observed
5 CSR 25-500.212 Transportation and Field Trips
Not Observed
5 CSR 25-500.222 Records and Reports
Not Observed
5 CSR 25-600.020 General Requirements
Violation
 Provider Comments
Violation
Criminal background check results were not on file for Hailey Gomez, Mary Goodwater, Marilyn Cook, and Corizma Blair.
Licensing Rule Reference
5 CSR 25-600.020 General Requirements (1) states: Prior to the employment or presence of a child care staff member in a family child care home, group child care home, child care center, or license-exempt facility not exempted by section 210.1080.13, RSMo, the child care provider shall request the results of a criminal background check for such child care staff member from the department.
Correction Required
Required results of criminal background checks shall be on file.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-600.040 Background Screening Findings
Not Observed
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. —
Not Observed
RSMo 210.211.  License required - exceptions - written notice of licensure status, when.
Not Observed