MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
TARILYN BELANGER LLC

Facility DVN
002756576

Phone
(573) 814-9061

Physical Address
14391 S CRUMP LN
ASHLAND
MO 65010-9101

Owner
TARILYN BELANGER LLC

Mailing Address

Provider/Director
BELANGER, TARILYN DAWN

E-mail Address
tarilyn_belanger@hotmail.com

Incorporated

Child Care Specialist
JOY LYNN NICHOLS

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
05/13/2022

Arrival Time
9:45 AM

Departure Time
10:41 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2423571278

Document	Document-Date
APPLICATION	01/25/2019
LLC ARTICLES OF ORGANIZATION	02/25/2019
DAILY SCHEDULE	02/25/2019
SAMPLE WEEKLY MENU	02/25/2019
CHILD CARE/DISCIPLINE POLICIES	02/25/2019
POLICIES	02/25/2019
OWNER/PROVIDER REFERENCES	03/13/2019
DIAGRAM/INDOOR	01/25/2019
DIAGRAM/OUTDOOR	01/25/2019
DISASTER AND EMERGENCY PREPAREDNESS PLAN	01/25/2019
SAFE SLEEP POLICY	04/16/2019
ASSISTANT APPROVAL REQUEST	04/16/2019
LLC OPERATING AGREEMENT	04/16/2019
ASSISTANT REFERENCES	05/02/2019
LICENSING ORIENTATION	02/25/2019
SANITATION INSPECTION	02/09/2022
FIRE/SAFETY INSPECTION	03/09/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	01/28/2022
EQUIPMENT LIST	01/28/2022
ANNUAL DECLARATION	01/28/2022
SAFETY PLAN	02/04/2021

Overlap Start Time	Overlap End Time	Overlap Submit Date
3:00PM	5:00PM	5/1/2019

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.

Attendance at Time of Inspection

Total Staff 1

Total Children 10

Staff	Child	Class Age	Note
1	10	MIXED	1 child age one; 9 children ages two to five; Tarilyn Belanger