DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

INDEPENDENCE 30 SCHOOL DISTRICT

002301057

(816) 521-5478

4300 S PHELPS RD
INDEPENDENCE
MO  64055-5102

INDEPENDENCE 30 SCHOOL DISTRICT

201 N FOREST AVE
INDEPENDENCE
MO  64050-2513

MAVERICK, MOSES

YOUTH_DEVELOPMENT@ISDSCHOOLS.ORG

Incorporated

JANA BARTON

5 YEARS - 11 YEARS

60

SCHOOL AGE

BEFORE AND AFTER SCHOOL CARE ONLY
 
Inspection Information

03/07/2022

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2418563181


DocumentDocument-Date
SAMPLE WEEKLY MENU 10/17/2011
POLICIES 10/17/2011
JOB RESPONSIBILITIES 10/17/2011
DISCIPLINE POLICIES 10/17/2011
DIRECTOR'S JOB RESPONSIBILITIES 10/17/2011
CHILD CARE PRACTICES 10/17/2011
SAMPLE FORMS 10/17/2011
LINES OF ADMINISTRATIVE AUTHORITY 10/17/2011
DAILY SCHEDULE 10/17/2011
DIRECTOR'S QUALIFICATIONS 08/24/2015
APPLICATION 08/01/2019
EQUIPMENT LIST 10/14/2021
STAFF SHEET 08/21/2019
ANNUAL DECLARATION 10/14/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 10/14/2021




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.

 
5 CSR 25-500.032 Organization and Administration
Compliance
5 CSR 25-500.042 Licensing Process
Compliance
5 CSR 25-500.052 Annual Requirements
Violation
 Provider Comments
Violation
The Annual Declaration was not submitted.
Licensing Rule Reference
5 CSR 25-500.052 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 group child care home or child care center and agreement to comply with all statutes and department licensing rules.
Correction Required
The facility shall submit the Annual Declaration as required.

Correction Verification
Submit Documentation

Compliance Date
10/14/2021
Violation
The staff sheet was not submitted.
Licensing Rule Reference
5 CSR 25-500.052 Annual Requirements (1) (D) states: A current staff sheet.
Correction Required
The facility shall submit a current staff sheet as required.

Correction Verification
Submit Documentation

Compliance Date
10/14/2021
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers
Violation
 Provider Comments
Violation
Hazardous items as follows were accessible to children: hand sanitizer and bleach. The item(s) was/were located in a hand sanitizer station on the wall in the Kids' Safari Room (hand sanitizer) and under the sink in an unlocked cabinet in the Kids' Safari Room (bleach).
Licensing Rule Reference
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (I) states: All flammable liquids, matches, cleaning supplies, poisonous materials, medicines, alcoholic beverages, hazardous personal care items or other hazardous items shall be inaccessible to children.
Correction Required
Hazardous items shall be inaccessible to children.

Correction Verification
Submit Documentation

Compliance Date
11/24/2021
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
Violation
 Provider Comments
Violation
The director was not responsible for the daily planning, monitoring and managing of the facilities program as evidence by no approved director onsite.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (2) (A) 1. . states: An approved certificated group child care home provider or center director shall be responsible for planning, monitoring, and managing the facility’s daily program.
Correction Required
The director or group home provider shall be responsible for the daily program.

Correction Verification
Submit Documentation

Compliance Date
11/16/2021
Violation
The facility has not submitted the approval request for proposed director: Moses Maverick.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (2) (A) 1. B. states: Once the center director or group child care home provider is certificated by the Department, the Center Director or Group Child Care Home Provider Approval Request form shall be submitted to the department and maintained on file at the facility. See Center Director or Group Child Care Home Provider Approval Request 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. This rule does not incorporate any subsequent amendment or additions.
Correction Required
An approval request form shall be submitted to the department.

Correction Verification
Submit Documentation

Compliance Date
10/15/2021
Violation
The facility does not have an approved director on staff.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (2) (A) 3. states: The licensee is required to maintain an approved certificated group child care home provider or center director on staff.
Correction Required
The facility shall have an approved director/group home provider.

Correction Verification
Submit Documentation

Compliance Date
11/16/2021
Violation
The department did not receive notification of a director change.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (2) (A) 6. states: The center owner(s), or the board president or chairperson, shall notify the department immediately when there is a change of directors and shall have a qualifying criminal background check on file as required by 19 CSR 30-63.020 General Requirements.
Correction Required
The facility shall notify SCCR immediately when there is a change of directors and submit required background check request.

Correction Verification
Submit Documentation

Compliance Date
10/15/2021
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 25-500.172 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
Child C, E, F, child(ren) records did not include child's birth date.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (A) states: The child's full name, address, birth-date and the date care begins and ends;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
3/4/2022
Violation
Child F child(ren) records did not include home 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
Submit Documentation

Compliance Date
3/4/2022
Violation
Child C, D, F 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
Submit Documentation

Compliance Date
3/4/2022
Violation
Child A, C, D child(ren) records did not include name of family physician or hospital.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (D) states: Name and phone number of the family physician, hospital, or both, to be used in an emergency;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
3/4/2022
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