MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

INSPECTION REPORT

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Facility Information

Facility Name

Facility DVN

Phone

Physical Address

Owner

Mailing Address

Provider/Director

E-mail Address

Incorporated

Child Care Specialist

Age Range

Capacity

Facility Type

Limitations

Inspection Information

Date

Arrival Time

Departure Time

Notice

Inspection Type

Inspection ID

Document	Document-Date
SAMPLE FORMS	02/07/2022
REGISTERING FICTITIOUS NAMES	02/12/2020
LLC ARTICLES OF ORGANIZATION	06/07/2016
APPLICATION	03/23/2020
EQUIPMENT LIST	07/12/2021
STAFF SHEET	08/13/2020
SANITATION INSPECTION	04/07/2021
FIRE/SAFETY INSPECTION	05/27/2021
SAMPLE WEEKLY MENU	08/16/2000
DAILY SCHEDULE	07/18/1996
SAFE SLEEP POLICY	01/21/2016
CHILD CARE PRACTICES	12/22/2009
DISASTER AND EMERGENCY PREPAREDNESS PLAN	12/22/2009
DISCIPLINE POLICIES	12/22/2009
POLICIES	12/22/2009
LINES OF ADMINISTRATIVE AUTHORITY	08/16/2000
JOB RESPONSIBILITIES	08/16/2000
LOCAL ZONING APPROVAL	09/14/2000
DIRECTOR'S QUALIFICATIONS	05/21/2010
DIAGRAM/OUTDOOR	08/15/2000
DIAGRAM/INDOOR	08/16/2000
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	07/12/2021
ANNUAL DECLARATION	07/12/2021

Overlap Start Time	Overlap End Time	Overlap Submit Date
12:50PM	2:50PM	1/29/2021

Open Violations:

NOTE

The licensee is responsible for compliance with all licensing rules, including but not limited to the rules listed on this compliance report form.

Staff	Child	Class Age	Note
3	29	MIXED	Staff: Jennifer Miller, Devan Miller, and Brandii Turner. Age range 2 years through 5 years. Four 2 year old children.
1	10	MIXED	Staff: Amy Fazio. Age range 2 years through 4 years. Four 2 year old children.


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 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 Compliance
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