MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT

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Facility Information

Facility Name
DOUGLASS COMMUNITY SERVICES, INCORPORATED

Facility DVN
000672599

Phone
(573) 221-1540

Physical Address
661 CLINIC RD
HANNIBAL
MO 63401-3607

Owner
DOUGLASS COMMUNITY SERVICES, INCORPORATED

Mailing Address
661 CLINIC RD
HANNIBAL
MO 63401-3607

Provider/Director
CAPP, ANNA LEE

E-mail Address
EHSCLINIC@DOUGLASSONLINE.ORG

Incorporated
Incorporated

Child Care Specialist
BETHANY C DUCKWORTH

Age Range
6 WEEKS - 35 MONTHS

Capacity
16

Facility Type
GROUP HOME AND CENTER

Limitations

Inspection Information

Date
04/11/2022

Arrival Time
2:01 PM

Departure Time
2:33 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2421420876

Document	Document-Date
ARTICLES OF INCORPORATION	06/02/2016
APPLICATION	08/25/2020
EQUIPMENT LIST	08/31/2021
CERTIFICATE OF GOOD STANDING	10/21/2021
STAFF SHEET	08/27/2020
FIRE/SAFETY INSPECTION	10/20/2021
SANITATION INSPECTION	06/01/2021
DIAGRAM/INDOOR	09/10/2002
DIAGRAM/OUTDOOR	09/10/2002
SAFE SLEEP POLICY	12/11/2015
LINES OF ADMINISTRATIVE AUTHORITY	04/27/2009
JOB RESPONSIBILITIES	06/15/2005
CHILD CARE PRACTICES	06/15/2005
POLICIES	06/15/2005
SAMPLE WEEKLY MENU	08/28/2001
SAMPLE FORMS	08/28/2001
DAILY SCHEDULE	08/28/2001
OWNER/PROVIDER REFERENCES	07/05/2001
DISCIPLINE POLICIES	03/03/2010
LLC ARTICLES OF ORGANIZATION	05/24/1993
DISASTER AND EMERGENCY PREPAREDNESS PLAN	08/06/2019
LOCAL ZONING APPROVAL	08/28/2008
DIRECTOR'S QUALIFICATIONS	01/30/2020
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	08/31/2021
ANNUAL DECLARATION	08/31/2021

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.

Attendance at Time of Inspection

Total Staff 5

Total Children 14

Staff	Child	Class Age	Note
2	7	MIXED	Staff: Sharea Salmon and Mary Brown. Age range 6 months through 2 years. Three 2 year old children.
2	7	MIXED	Staff: Anna Capp and Jean Dunaway. Age range 9 months through 2 years. Four 2 year old children.
1	0	NO CHILDREN IN ATTENDANCE	Staff: Kathy Couch. Cook. Not counted in child/staff ratio.


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