MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT

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Facility Information

Facility Name
BLAIR, DONNA K

Facility DVN
001563660

Phone
(417) 546-3990

Physical Address
614 ROCKHILL DR
FORSYTH
MO 65653-5383

Owner
BLAIR, DONNA K

Mailing Address
PO BOX 941
FORSYTH
MO 65653-0941

Provider/Director
BLAIR, DONNA K

E-mail Address
larryblair65614@yahoo.com

Incorporated

Child Care Specialist
BILLIE RUSSELL

Age Range
6 WEEKS - 12 YEARS

Capacity
20

Facility Type
GROUP HOME AND CENTER

Limitations
4 CHILDREN UNDER 24 MONTHS

Inspection Information

Date
02/28/2022

Arrival Time
11:20 AM

Departure Time
11:59 AM

Notice
UNANNOUNCED

Inspection Type
REINSPECTION

Inspection ID
2418780479

Document	Document-Date
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	12/08/2021
ANNUAL DECLARATION	12/08/2021
OWNER/PROVIDER REFERENCES	02/20/2001
SAMPLE WEEKLY MENU	12/01/2011
POLICIES	07/23/2009
LOCAL BUILDING APPROVAL	12/20/2001
LOCAL ZONING APPROVAL	12/20/2001
LINES OF ADMINISTRATIVE AUTHORITY	12/20/2001
JOB RESPONSIBILITIES	12/20/2001
DISCIPLINE POLICIES	07/23/2009
DIRECTOR'S QUALIFICATIONS	01/02/2001
DIAGRAM/OUTDOOR	10/28/2004
DIAGRAM/INDOOR	08/05/2004
DAILY SCHEDULE	12/01/2001
CHILD CARE PRACTICES	07/23/2009
LOCAL FIRE DEPARTMENT NOTIFICATION	07/10/2017
SANITATION INSPECTION	12/08/2021
FIRE/SAFETY INSPECTION	09/08/2021
APPLICATION	06/26/2019
STAFF SHEET	06/26/2019
EQUIPMENT LIST	12/08/2021
SAFE SLEEP POLICY	12/09/2019
DISASTER AND EMERGENCY PREPAREDNESS PLAN	12/09/2019

Overlap Start Time	Overlap End Time	Overlap Submit Date
3:15PM	5:15PM	6/11/2013

Inspection determined facility to be in compliance with licensing rules.

Open Violations: 4

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 3

Total Children 18

Staff	Child	Class Age	Note
1	3	INFANTS AND TODDLERS	Caregiver, Tammy Pollard, was with three (3) children under 24 months.
1	10	PRESCHOOL	Caregiver, Donna Blair, was with one (1) three (3) year old, seven (7) four (4) year old and two (2) five (5) year old children.
1	5	TWO YEAR OLDS	Caregiver, Meghan Holvica, was with five (5) two (2) year old children.

Compliance List
5 CSR 25-500.032 Organization and Administration Not Observed
5 CSR 25-500.042 Licensing Process Violation
5 CSR 25-500.052 Annual Requirements Not Observed
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers Not Observed
5 CSR 25-500.087 Fire Safety Not Observed
5 CSR 25-500.090 Disaster and Emergency Preparedness Not Observed
5 CSR 25-500.092 Furniture, Equipment and Materials Not Observed
5 CSR 25-500.102 Personnel Violation
5 CSR 25-500.112 Staff/Child Ratios Violation
5 CSR 25-500.122 Medical Examination Reports Not Observed
5 CSR 25-500.132 Admission Policies and Procedures Not Observed
5 CSR 25-500.142 Nighttime Care Not Observed
5 CSR 25-500.152 Hourly Care Facilities Not Observed
5 CSR 25-500.162 Overlap Care of Children Not Observed
5 CSR 25-500.172 Emergency School Closings Not Observed
5 CSR 25-500.182 Child Care Program Violation
5 CSR 25-500.192 Health Care Not Observed
5 CSR 25-500.202 Nutrition and Food Service Not Observed
5 CSR 25-500.212 Transportation and Field Trips Not Observed
5 CSR 25-500.222 Records and Reports Not Observed
5 CSR 25-600.020 General Requirements Violation
5 CSR 25-600.040 Background Screening Findings Not Observed
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. — Not Observed
RSMo 210.211. License required - exceptions - written notice of licensure status, when. Not Observed