DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

WAVERLY FOREST ACADEMY, LLC

002140516

(636) 940-0550

3545 FRANKS DR
ST CHARLES
MO  63301-4041

WAVERLY FOREST ACADEMY, LLC



 

SCHOMAKER, AMBER R

INFO@WAVERLYFOREST.COM


KATHERINE D SIMS

6 WEEKS - 12 YEARS

93

GROUP HOME AND CENTER

9 CHILDREN UNDER 12 MONTHS; 25 CHILDREN UNDER 24 MONTHS
 
Inspection Information

03/15/2022

11:50 AM

1:10 PM

UNANNOUNCED

COMPLIANCE MONITORING

2419777941


DocumentDocument-Date
SAMPLE WEEKLY MENU 03/10/2009
POLICIES 03/10/2009
LINES OF ADMINISTRATIVE AUTHORITY 03/10/2009
JOB RESPONSIBILITIES 03/10/2009
DISCIPLINE POLICIES 03/10/2009
DAILY SCHEDULE 03/10/2009
CHILD CARE PRACTICES 03/10/2009
DIRECTOR'S QUALIFICATIONS 03/23/2009
SAMPLE FORMS 03/19/2009
DIAGRAM/OUTDOOR 03/10/2009
DIAGRAM/INDOOR 03/10/2009
LOCAL ZONING APPROVAL 03/19/2009
LLC OPERATING AGREEMENT 03/10/2009
LLC ARTICLES OF ORGANIZATION 03/10/2009
LOCAL BUILDING APPROVAL 01/11/2017
LOCAL FIRE DEPARTMENT NOTIFICATION 03/10/2009
SAFE SLEEP POLICY 10/22/2018
CERTIFICATE OF GOOD STANDING 01/17/2019
APPLICATION 10/23/2018
DISASTER AND EMERGENCY PREPAREDNESS PLAN 01/02/2019
STAFF SHEET 01/18/2019
EQUIPMENT LIST 02/10/2022
SANITATION INSPECTION 12/16/2021
FIRE/SAFETY INSPECTION 01/10/2022
ANNUAL DECLARATION 02/14/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 03/15/2022




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 10
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 15
Total Children 73
StaffChildClass AgeNote
2 8 INFANTS AND TODDLERS Madison Wedekin and Morgan Knobbe present with 8 children, ages 6 weeks to 1 year old
2 8 INFANTS AND TODDLERS Haleigh Schroer and Carlie Tunnel present with 8 children, ages 1-2 years old
2 8 INFANTS AND TODDLERS Teresa Schmidtberger and Macy Nesslage present with 8 children, all 1 year old
2 14 MIXED Jaelyn Blake and Melissa Holmes present with 14 children, ages 2-3 years old
3 0 NO CHILDREN IN ATTENDANCE Amber Schomaker, Sydney Schulz, and Michelle Fischer present with no children in attendance
2 18 PRESCHOOL Pieper Ramey and Ashley Smith present with 18 children, ages 3-4 years old
2 17 PRESCHOOL Janis Kopecky and Hannah Menke present with 17 children, all 4 years old

 
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 Family Care Safety Registry check was not conducted for Brooke Bady, Jaelyn Blake, Renee Byrnes, Claire Chase, MIchele Fischer, Melissa Holmes, Renee Knobbe, Janis Kopecky, Angela Nesslage, Macy Nesslage, Amber Schomaker, Sydney Schulz, Ashley Smith, Carlie Tunnell, Madison Wedekin,, and Pieper Ramey within thirty (30) days prior to the anniversary date.
Licensing Rule Reference
5 CSR 25-500.052 Annual Requirements (2) (C) states: The child care provider shall conduct a Family Care Safety Registry check for all child care staff members within thirty (30) days prior to the anniversary date as printed on the license.
Correction Required
Required Family Care Safety Registry checks shall be conducted for all child care staff member(s) within thirty (30) days prior to the anniversary date.

Correction Verification
Submit Documentation

Compliance Date

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
Violation
 Provider Comments
Violation
The requirements for sleeping materials were not met as evidenced by 8 children 12 months or older, who nap or sleep, did not have a sheet.
Licensing Rule Reference
5 CSR 25-500.092 Furniture, Equipment and Materials (1) (B) 1. A. states: An individual cot or bed shall be provided for each child who naps or sleeps. An individually assigned sheet and blanket shall be provided for each child twelve (12) months and older who naps or sleeps. Upper levels of bunk beds shall not be used.
Correction Required
The facility shall provide sleeping equipment and bedding as required.

Correction Verification
Corrected on Site

Compliance Date
3/15/2022
5 CSR 25-500.102 Personnel
Violation
 Provider Comments
Violation
A caregiver did not obtain one clock hour of training for each month of employment. The staff listed need the following information: Macy Nessalge needs 1 more hour and Sydney Schulz needs 1 more hours for 2021.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (3) (C) states: Caregivers who were employed after the first of the year shall obtain one (1) clock of hour training for each one (1) month of employment, regardless of the date employment began.
Correction Required
Required training hours shall be documented for each employee.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-500.112 Staff/Child Ratios
Compliance
5 CSR 25-500.122 Medical Examination Reports
Violation
 Provider Comments
Violation
Medical examination report(s) was/were not on file for Renee Byrnes and Teresa Schmidtberger as evidenced by a medical examination was not on file within 30 days of an individual beginning to work with children.
Licensing Rule Reference
5 CSR 25-500.122 Medical Examination Reports (1) (A) states: All persons working in a day care facility in any capacity during child care hours, including volunteers counted in staff/child ratios, shall be in good physical and emotional health with no physical or mental conditions which would interfere with child care responsibilities. These persons shall have a medical examination report, signed by a licensed physician or registered nurse who is under the supervision of a licensed physician, on file at the facility at the time of initial licensure or within thirty (30) days following employment.
Correction Required
Medical reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
A medical examination report did not include a completed Risk Assessment for Tuberculosis form for Renee Byrnes.
Licensing Rule Reference
5 CSR 25-500.122 Medical Examination Reports (1) (B) . states: Medical examination reports shall include a “Risk Assessment for Tuberculosis” form, included herein, completed and signed by a health care professional, as provided by the Missouri Department of Health and Senior Services (MDHSS). If the person has signs or symptoms of tuberculosis, or risk factors for tuberculosis, then testing for tuberculosis shall occur.
Correction Required
TB reports shall be on file as required

Correction Verification
Submit Documentation

Compliance Date

Violation
Medical examination report form did not contain all required information as evidenced by Carlie Tunnell needs yes/no box completed on the medical exam.
Licensing Rule Reference
5 CSR 25-500.122 Medical Examination Reports (1) (D) states: The medical examination report form shall be supplied by the department or the facility may use its own form if it contains all the information on the department's form.
Correction Required
Medical reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-500.132 Admission Policies and Procedures
Violation
 Provider Comments
Violation
An individualized plan for specialized care for a child with special physical, developmental or behavioral needs was not on file.
Licensing Rule Reference
5 CSR 25-500.132 Admission Policies and Procedures (6) states: A child who has a special physical, developmental or behavioral need shall have on file an individualized plan for specialized care from a professionally qualified source.
Correction Required
An individualized plan from a professional source shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility did not meet requirements for child enrollment and health information as evidenced by Child B needs aithorization for emergency medical care completed.
Licensing Rule Reference
5 CSR 25-500.132 Admission Policies and Procedures (8) (E) 4. 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

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
Violation
 Provider Comments
Violation
1 child(ren) records did not include date care begins and ends.
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

Violation
4 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

5 CSR 25-600.020 General Requirements
Violation
 Provider Comments
Violation
Criminal background check results were not on file for Macy Nesslage, Melissa Holmes, Morgan Knobbe, Haleigh Schroer, and Pieper Ramey.
Licensing Rule Reference
5 CSR 25-600.020 General Requirements (1) states: Prior to the employment or presence of a child care staff member in a family child care home, group child care home, child care center, or license-exempt facility not exempted by section 210.1080.13, RSMo, the child care provider shall request the results of a criminal background check for such child care staff member from the department.
Correction Required
Required results of criminal background checks shall be on file.

Correction Verification
Submit Documentation

Compliance Date

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