DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

KIRKSVILLE R-III SCHOOL DISTRICT

002011727

(660) 626-1459

1405 S COTTAGE GROVE
KIRKSVILLE
MO  63501

KIRKSVILLE R-III SCHOOL DISTRICT



 

KLOCKE, MELISSA ROSE

mklocke@kirksville.k12.mo.us


BETHANY C DUCKWORTH

6 WEEKS - 6 YEARS

175

GROUP HOME AND CENTER

16 CHILDREN UNDER 24 MONTHS
 
Inspection Information

01/24/2022

8:55 AM

11:07 AM

UNANNOUNCED

COMPLIANCE MONITORING

2416662199


DocumentDocument-Date
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 05/04/2021
ANNUAL DECLARATION 05/04/2021
SAMPLE WEEKLY MENU 02/27/2008
LINES OF ADMINISTRATIVE AUTHORITY 02/27/2008
DIRECTOR'S JOB RESPONSIBILITIES 02/27/2008
JOB RESPONSIBILITIES 02/27/2008
DAILY SCHEDULE 03/17/2010
DIRECTOR'S QUALIFICATIONS 04/28/2008
CHILD CARE PRACTICES 04/11/2016
DISCIPLINE POLICIES 04/11/2016
POLICIES 04/11/2016
EQUIPMENT LIST 05/11/2021
STAFF SHEET 07/29/2020
FIRE/SAFETY INSPECTION 03/30/2021
DIAGRAM/INDOOR 03/10/2008
DIAGRAM/OUTDOOR 03/10/2008
SAMPLE FORMS 03/04/2008
SAFE SLEEP POLICY 03/01/2016
DISASTER AND EMERGENCY PREPAREDNESS PLAN 11/06/2019
APPLICATION 03/10/2020
SANITATION INSPECTION 03/25/2021




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.
Attendance at Time of Inspection
Total Staff 33
Total Children 107
StaffChildClass AgeNote
1 4 INFANTS AND TODDLERS Staff: Catherine Tyler. Age range 11 months through 23 months.
2 15 MIXED Staff: Angel Grogan and Shanea Rusk. Age range 4 years through 5 years.
3 17 MIXED Staff: Brittney Athon, Rachel McLachlan, and Chloe Allemang. Age range 3 years through 5 years.
3 9 MIXED Staff: Pam Kilmer, Joyce Kerr, and Jessie Hageman. Age range 4 years through 5 years.
3 13 MIXED Staff: Michelle Muffley, Stacy Xander, and Mikki Cowan. Age range 3 years through 5 years.
2 10 MIXED Staff: Robert Bray and Jill Scheurer. Age range 4 years through 5 years.
2 0 NO CHILDREN IN ATTENDANCE Staff: Melissa Klocke, Director, and Mary Elam, Secretary.
3 6 PRESCHOOL Staff: Chrissy Hendren, Chandra Noyes, and Karen Burns. Age rang 3 years through 4 years.
1 2 PRESCHOOL Staff: Whitney Burns. All children 4 years old.
6 4 PRESCHOOL Staff: Alexis Luebbering, Lynn Kizzire, Sheila Smith, Krystal Wilcox, Cecily Reese, and Lisa Lambert. Age range 3 years through 4 years.
3 14 PRESCHOOL Staff: Hailey Baker, Kara Schwend, and Jimi Motter. Age range 3 years through 4 years.
2 7 PRESCHOOL Staff: Sandy Adams and Katie Grossnickle. Ages 3 years and 4 years.
2 6 TWO YEAR OLDS Staff: Jennifer Potter and McKayla Walker. All children 2 years of age.

 
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
Violation
 Provider Comments
Violation
The facility did not meet requirements for child enrollment and health information on file as evidenced by one (1) child(s) file did not have the parental acknowledgement they have received a copy of the provider's safe sleep policy.
Licensing Rule Reference
5 CSR 25-500.132 Admission Policies and Procedures (8) (E) 8. E. states: They have received a copy of the provider's safe sleep policy when enrolling children less than one (1) year of age.
Correction Required
Child enrollment information shall be completed and on file as requested.

Correction Verification
Corrected on Site

Compliance Date
1/24/2022
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
One child(ren) records did not include work telephone number of parent(s), guardian or legal custodian.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Corrected on Site

Compliance Date
1/24/2022
Violation
One child(ren) records did not include work schedule of parent(s), guardian or legal custodian.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Corrected on Site

Compliance Date
1/24/2022
Violation
One child(ren) records did not include employers' address of parent(s), guardian or legal custodian.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Corrected on Site

Compliance Date
1/24/2022
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