MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT

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Facility Information

Facility Name
THE CRAYON ACADEMY, LLC

Facility DVN
002751900

Phone
(417) 362-9287

Physical Address
122 S JACKSON ST
MOUNTAIN VIEW
MO 65548-7410

Owner
THE CRAYON ACADEMY, LLC

Mailing Address
5518 S KIMBROUGH AVE
SPRINGFIELD
MO 65810-2730

Provider/Director
SOUTHWORTH, CAITLYN NICOLE

E-mail Address
HEATHERDEANN6@GMAIL.COM

Incorporated

Child Care Specialist
THERESA BINKLEY

Age Range
24 MONTHS - 12 YEARS

Capacity
20

Facility Type
GROUP HOME AND CENTER

Limitations

Inspection Information

Date
06/02/2022

Arrival Time
3:08 PM

Departure Time
3:44 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2424721405

Document	Document-Date
APPLICATION	12/31/2018
DIAGRAM/INDOOR	02/13/2019
DIAGRAM/OUTDOOR	02/13/2019
DISASTER AND EMERGENCY PREPAREDNESS PLAN	02/13/2019
OWNER/PROVIDER REFERENCES	02/13/2019
LLC ARTICLES OF ORGANIZATION	01/15/2019
DAILY SCHEDULE	03/13/2019
LOCAL FIRE DEPARTMENT NOTIFICATION	03/04/2019
LINES OF ADMINISTRATIVE AUTHORITY	03/13/2019
LLC OPERATING AGREEMENT	03/13/2019
CHILD CARE PRACTICES	03/13/2019
DISCIPLINE POLICIES	03/13/2019
POLICIES	03/13/2019
JOB RESPONSIBILITIES	03/15/2019
SAMPLE WEEKLY MENU	03/15/2019
DIRECTOR'S QUALIFICATIONS	03/22/2019
STAFF SHEET	01/10/2022
LOCAL ZONING APPROVAL	03/25/2019
ANNUAL DECLARATION	01/11/2022
EQUIPMENT LIST	01/10/2022
SANITATION INSPECTION	11/19/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	01/10/2022
FIRE/SAFETY INSPECTION	11/02/2021

Overlap Start Time	Overlap End Time	Overlap Submit Date
3:30PM	4:30PM	4/6/2020
7:30AM	8:30AM	4/6/2020

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 3

Total Children 19

Staff	Child	Class Age	Note
3	19	MIXED	Caitlyn Southworth, Heather Hawkins, Madison Jeffries with Nineteen children. One child is 8 years old, Three children 2 years old, Eight children 3 years old and Seven children 4 years old.

Compliance List
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