DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

LICENSE EXEMPT PROGRAM INSPECTION REPORT
Facility Information

ST. MATTHEW PRESCHOOL

001620562

(816) 524-4354

700 NE CHIPMAN RD
LEES SUMMIT
MO  64063

ST. MATTHEW LUTHERAN CHURCH



 

RINEHART, TRACI RENEE

stmatthewps@gracefaithlove.org

Incorporated

BEN NEWTON

24 MONTHS - 5 YEARS

61

LICENSE EXEMPT PROGRAM

 
Inspection Information

01/20/2022

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2416666801


DocumentDocument-Date
SANITATION INSPECTION 11/15/2021
FIRE/SAFETY INSPECTION 01/05/2022
NOTICE OF PARENTAL RESPONSIBILITY 01/04/2021




Inspection determined facility to be in compliance with rules.
Open Violations: NA

 
5 CSR 25-300.020 Application for Annual Fire Safety and Health and Sanitation Inspections and Inspection Procedures
Compliance
5 CSR 25-300.040 Staffing Requirements
Compliance
5 CSR 25-300.050 Health Requirements
Violation
 Provider Comments
Violation
Requirements for children's medical examination reports were not met as evidenced by there was no medical examination report on file within 30 days of admission - the admission date(s) was/were 8/24/2021 (Child D).
Licensing Rule Reference
5 CSR 25-300.050 Health Requirements (2) states: Within thirty (30) days following the admission of an infant, toddler or preschool child, a physical assessment report signed by a licensed physician or registered professional nurse shall be on file at the facility. The facility may use the department's physical assessment form, MO 580-1878 (6-94), or the facility may use its own form if it contains all the information on the department's form. The report shall have been completed not more than twelve (12) months before admission.
Correction Required
Children's physical assessment reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date
1/20/2022
5 CSR 25-300.060 Responsibilities of Caregivers
Compliance
5 CSR 25-300.070 Fire Safety Requirements
Compliance
5 CSR 25-300.080 Sanitation Requirements
Compliance
5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment
Compliance
5 CSR 25-300.100 Transportation and Field Trip Requirements
Compliance
5 CSR 25-300.110 Admission Procedures and Required Reports and Records
Compliance
5 CSR 25-600.020 General Requirements
Compliance
5 CSR 25-600.040 Background Screening Findings
Compliance
RSMo 210.003 Immunizations of children required, when, exceptions--duties of administrator, report--notification of parents, when.
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.
Compliance
RSMo 210.254 Religious organization operating facilities exempt under licensing laws required to file parental notice of responsibility and fire, safety inspections annually.
Compliance
RSMo 210.255 Religious organizations operating facility in violation, procedure - noncompliance after notice, prosecutor may act or attorney general.
Compliance
RSMo 252. Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized.
Compliance