MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
JOHNSON, KIMBERLY LYNN

Facility DVN
001249152

Phone
(573) 445-2193

Physical Address
1910 POTOMAC DR
COLUMBIA
MO 65203-5843

Owner
JOHNSON, KIMBERLY LYNN

Mailing Address

Provider/Director
JOHNSON, KIMBERLY LYNN

E-mail Address
JOHNSONKIMBO44@GMAIL.COM

Incorporated

Child Care Specialist
CYNTHIA D MADDOX

Age Range
BIRTH - 12 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
05/11/2022

Arrival Time
11:04 AM

Departure Time
11:41 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2423394646

Document	Document-Date
OWNER/PROVIDER REFERENCES	05/23/2003
ASSISTANT REFERENCES	07/18/2011
SAMPLE WEEKLY MENU	05/23/2003
POLICIES	05/23/2003
CHILD CARE/DISCIPLINE POLICIES	02/23/2003
DAILY SCHEDULE	05/23/2003
DIAGRAM/OUTDOOR	05/23/2003
DIAGRAM/INDOOR	05/23/2003
APPLICATION	06/12/2019
EQUIPMENT LIST	09/16/2021
ASSISTANT APPROVAL REQUEST	07/18/2011
DISASTER AND EMERGENCY PREPAREDNESS PLAN	03/03/2020
SAFE SLEEP POLICY	03/03/2020
FIRE/SAFETY INSPECTION	07/08/2021
SANITATION INSPECTION	07/07/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	09/16/2021
ANNUAL DECLARATION	09/16/2021

Overlap Start Time	Overlap End Time	Overlap Submit Date
4:30PM	5:30PM	8/7/2009
7:30AM	8:30AM	8/7/2009

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 1

Total Children 9

Staff	Child	Class Age	Note
1	9	MIXED	Kim Johnson was the provider with the children. Children range in age from 1 year to 5 years with 1 child under 2 years of age.


5 CSR 25-400.025 Organization and Administration Compliance
5 CSR 25-400.045 Licensing Process Compliance
5 CSR 25-400.055 Annual Requirements Compliance
5 CSR 25-400.085 Physical Requirements of the Family Day Care Home Compliance
5 CSR 25-400.086 Fire Safety Compliance
5 CSR 25-400.090 Disaster and Emergency Preparedness Compliance
5 CSR 25-400.095 Furniture, Equipment and Materials Compliance
5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel Compliance
5 CSR 25-400.115 Day Care Family and Household Compliance
5 CSR 25-400.125 Medical Examination Reports Compliance
5 CSR 25-400.135 Admission Policies and Procedures Compliance
5 CSR 25-400.145 Nighttime Care Compliance
5 CSR 25-400.155 Overlap Care of Children Compliance
5 CSR 25-400.165 Emergency School Closings Compliance
5 CSR 25-400.175 Child Care Program Compliance
5 CSR 25-400.185 Health Care Compliance
5 CSR 25-400.190 Nutrition and Food Service Compliance
5 CSR 25-400.200 Transportation and Field Trips Compliance
5 CSR 25-400.210 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
RSMo 210.252. Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized. Compliance