MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
MOELLER, CAROL ANN

Facility DVN
000208224

Phone
(314) 966-8988

Physical Address
1125 SIMMONS AVE
KIRKWOOD
MO 63122-1110

Owner
MOELLER, CAROL ANN

Mailing Address

Provider/Director
MOELLER, CAROL ANN

E-mail Address
CMOELLER4@ICLOUD.COM

Incorporated

Child Care Specialist
KATHERINE D SIMS

Age Range
BIRTH - 6 YEARS

Capacity
10

Facility Type
FAMILY HOME

Limitations
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

Date
03/08/2022

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2419341393

Document	Document-Date
ANNUAL DECLARATION	01/10/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	01/20/2022
SAFETY PLAN	01/27/2021
SAMPLE WEEKLY MENU	04/14/1986
SAMPLE FORMS	04/14/1986
POLICIES	04/14/1986
OWNER/PROVIDER REFERENCES	04/14/1986
LOCAL FIRE DEPARTMENT NOTIFICATION	04/14/1986
DIAGRAM/OUTDOOR	04/14/1986
DIAGRAM/INDOOR	04/14/1986
DAILY SCHEDULE	04/14/1986
CHILD CARE/DISCIPLINE POLICIES	04/14/1986
ASSISTANT REFERENCES	11/07/2013
ASSISTANT APPROVAL REQUEST	11/07/2013
SAFE SLEEP POLICY	12/20/2017
DISASTER AND EMERGENCY PREPAREDNESS PLAN	07/23/2012
FIRE/SAFETY INSPECTION	11/08/2021
SANITATION INSPECTION	12/03/2021
EQUIPMENT LIST	01/10/2022
APPLICATION	10/18/2019

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.