DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT
Facility Information

SHAPES & COLORS

001660877

(314) 429-0221

4417 BILOXI AVE
BERKELEY
MO  63134-3413

HICKS, YOLANDA SHERILL



 

HICKS, YOLANDA SHERILL

yolandahicks33@yahoo.com


KATHERINE D SIMS

6 WEEKS - 12 YEARS

10

FAMILY HOME

IF ONLY 4 CHILDREN PRESENT, ALL CHILDREN MAY BE UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 10 CHILDREN IN CARE NO MORE THAN 2 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 10 CHILDREN IN CARE NO MORE THAN 4 CHILDREN UNDER AGE 2 WITH 2 ADULT CAREGIVERS; UP TO 6 CHILDREN IN CARE NO MORE THAN 3 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER
 
Inspection Information

01/27/2022

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2416856780


DocumentDocument-Date
SAMPLE WEEKLY MENU 10/07/2002
SAMPLE FORMS 10/07/2002
DAILY SCHEDULE 10/07/2002
CHILD CARE/DISCIPLINE POLICIES 10/07/2002
ASSISTANT APPROVAL REQUEST 09/01/2010
DIAGRAM/OUTDOOR 07/13/2010
DIAGRAM/INDOOR 07/13/2010
REGISTERING FICTITIOUS NAMES 08/02/2016
POLICIES 10/07/2002
EQUIPMENT LIST 09/30/2021
APPLICATION 08/16/2018
SAFE SLEEP POLICY 08/16/2018
DISASTER AND EMERGENCY PREPAREDNESS PLAN 09/19/2018
SANITATION INSPECTION 07/26/2021
FIRE/SAFETY INSPECTION 07/13/2021

Overlap Start TimeOverlap End TimeOverlap Submit Date
  6:30AM   8:30AM   12/11/2019



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 25-400.025 Organization and Administration
Compliance
5 CSR 25-400.045 Licensing Process
Compliance
5 CSR 25-400.055 Annual Requirements
Violation
 Provider Comments
Violation
The Annual Declaration was not submitted.
Licensing Rule Reference
5 CSR 25-400.055 Annual Requirements (1) (A) states: An Annual Declaration for Licensed Facility form, promulgated as of 2020 and incorporated by reference in this rule. As published by the Missouri Department of Health and Senior Services, PO Box 570, Jefferson City, MO 65102-0570 and available by the department at https://health.mo.gov/safety/childcare/forms.php indicating the licensee’s intent to continue operating a licensed family child care home and agreement to comply with all statutes and department licensing rules.
Correction Required
The child care provider shall submit the Annual Declaration as required.

Correction Verification
Submit Documentation

Compliance Date
10/14/2021
Violation
The listing of household members and assistants was not submitted.
Licensing Rule Reference
5 CSR 25-400.055 Annual Requirements (1) (C) states: A listing of household members and assistant(s).
Correction Required
The child care provider shall submit a listing of all household members and assistants.

Correction Verification
Submit Documentation

Compliance Date
10/14/2021
5 CSR 25-400.085 Physical Requirements of the Family Day Care Home
Compliance
5 CSR 25-400.086 Fire Safety
Violation
 Provider Comments
Violation
Requirements of 19 CSR 30-61.086 Fire Safety were not met as evidenced by the disaster and tornado drill record was not available on the premises.
Licensing Rule Reference
5 CSR 25-400.086 Fire Safety 2 (C) states: Child care staff shall conduct at least one (1) fire drill each month and a disaster drill at least every three (3) months. The disaster drills shall include tornado drills. The provider shall maintain a written record at the facility of the date, type of drill, time required to evacuate the building, and number of children present during the drill.
Correction Required
Fire, tornado, and other disaster drills shall be completed and recorded as required.

Correction Verification
Submit Documentation

Compliance Date
12/2/2021
Violation
Requirements of 19 CSR 30-61.086 Fire Safety were not met as evidenced by the fire drill record was not available on the premises.
Licensing Rule Reference
5 CSR 25-400.086 Fire Safety 2 (C) states: Child care staff shall conduct at least one (1) fire drill each month and a disaster drill at least every three (3) months. The disaster drills shall include tornado drills. The provider shall maintain a written record at the facility of the date, type of drill, time required to evacuate the building, and number of children present during the drill.
Correction Required
Fire, tornado, and other disaster drills shall be completed and recorded as required.

Correction Verification
Submit Documentation

Compliance Date
12/2/2021
5 CSR 25-400.090 Disaster and Emergency Preparedness
Compliance
5 CSR 25-400.095 Furniture, Equipment and Materials
Compliance
5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel
Violation
 Provider Comments
Violation
Verification of safe sleep training was not documented and maintained for David Hicks Jr.
Licensing Rule Reference
5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel (5) (A) states: The training shall be documented and maintained as described in paragraph (4)(E)2. of this rule.
Correction Required
Safe sleep training shall be documented and maintained.

Correction Verification
Submit Documentation

Compliance Date
1/27/2022
5 CSR 25-400.115 Day Care Family and Household
Compliance
5 CSR 25-400.125 Medical Examination Reports
Violation
 Provider Comments
Violation
Child's medical examination report did not contain evidence that child’s current health is satisfactory for participation in a day care program.
Licensing Rule Reference
5 CSR 25-400.125 Medical Examination Reports (2) (B) states: Examination reports shall determine if a child's medical history and current state of health is satisfactory for participation in a day care program.
Correction Required
Child medical requirements shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
12/2/2021
5 CSR 25-400.135 Admission Policies and Procedures
Violation
 Provider Comments
Violation
The facility did not meet requirements for child enrollment and health information as evidenced by Child A needs authorization for emergency medical care.
Licensing Rule Reference
5 CSR 25-400.135 Admission Policies and Procedures (6) (E) 3 states: Instructions for action to be taken if the parent(s) or physician designated by the parent(s) cannot be reached in an emergency and permission for emergency medical care.
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
12/14/2021
5 CSR 25-400.145 Nighttime Care
Compliance
5 CSR 25-400.155 Overlap Care of Children
Compliance
5 CSR 25-400.165 Emergency School Closings
Compliance
5 CSR 25-400.175 Child Care Program
Compliance
5 CSR 25-400.185 Health Care
Compliance
5 CSR 25-400.190 Nutrition and Food Service
Compliance
5 CSR 25-400.200 Transportation and Field Trips
Compliance
5 CSR 25-400.210 Records and Reports
Compliance
5 CSR 25-600.020 Background Screening Findings
Compliance
5 CSR 25-600.040 General Requirements
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
RSMo 210.252. Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized.
Compliance