MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
HERSHBERGER, GLORIA

Facility DVN
000312790

Phone
(816) 781-3551

Physical Address
8409 ORCHARD CIR
PLEASANT VALLEY
MO 64068-7802

Owner
HERSHBERGER, GLORIA

Mailing Address

Provider/Director
HERSHBERGER, GLORIA

E-mail Address
GLORIAHERSHBERGER@YAHOO.COM

Incorporated

Child Care Specialist
MACIE L HERRIG

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 6 CHILDREN IN CARE NO MORE THAN 3 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

Inspection Information

Date
07/07/2022

Arrival Time
10:45 AM

Departure Time
11:38 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2426685499

Document	Document-Date
POLICIES	09/16/1997
DIAGRAM/OUTDOOR	11/01/1997
DIAGRAM/INDOOR	11/01/1997
DAILY SCHEDULE	09/16/1997
SAMPLE WEEKLY MENU	10/28/1997
OWNER/PROVIDER REFERENCES	09/29/1997
CHILD CARE/DISCIPLINE POLICIES	09/16/1997
ASSISTANT APPROVAL REQUEST	02/18/2015
ASSISTANT REFERENCES	02/09/2015
SAMPLE FORMS	09/16/1997
APPLICATION	09/12/2019
EQUIPMENT LIST	10/05/2021
SANITATION INSPECTION	07/25/2021
FIRE/SAFETY INSPECTION	08/16/2021
ANNUAL DECLARATION	10/05/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	10/05/2021

Overlap Start Time	Overlap End Time	Overlap Submit Date
3:00PM	4:00PM	9/30/2013
7:30AM	8:30AM	9/30/2013

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 4

Total Children 10

Staff	Child	Class Age	Note
1	10	MIXED	provider Gloria Hershberger and caregiver Amery Hershberger present with ten children, three 2-years-old, five 3-to-5-years-old, and two school age
3	0	NO CHILDREN IN ATTENDANCE	additional adult household member present include Seth Hershberger and Ian Hershberger and child household member Gloria Hershberger

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

Violation

	Provider Comments
Violation Hazardous items as follows were accessible to children: Hot Shine Foam cleaner spray, Infinity primer, and Rustoleum spray cleaner. The item(s) was/were located in an unlocked closet in the living room. Licensing Rule Reference 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (1) (J) states: All flammable liquids, matches, cleaning supplies, poisonous materials, medicines, alcoholic beverages, hazardous personal care items or other hazardous items shall be inaccessible to children. Correction Required Hazardous items shall be inaccessible to children. Correction Verification Corrected on Site Compliance Date 7/7/2022

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 Child 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