DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

LICK CREEK ADVENTURES DAYCARE AND PRESCHOOL

002595231

(573) 721-5523

105 W MAIN ST
PERRY
MO  63462-1105

STEVENER, KAYLA

24311 SALT LICK PL
PERRY
MO  63462-2069

STEVENER, KAYLA

mossk03@hotmail.com


BETHANY C DUCKWORTH

6 WEEKS - 12 YEARS

20

GROUP HOME AND CENTER

4 CHILDREN UNDER 24 MONTHS
 
Inspection Information

07/13/2022

9:58 AM

10:31 AM

UNANNOUNCED

COMPLIANCE MONITORING

2426989641


DocumentDocument-Date
ANNUAL DECLARATION 01/19/2022
APPLICATION 10/21/2019
DISASTER AND EMERGENCY PREPAREDNESS PLAN 12/04/2019
DAILY SCHEDULE 11/05/2019
EQUIPMENT LIST 01/19/2022
DIAGRAM/INDOOR 12/04/2019
DIAGRAM/OUTDOOR 12/05/2019
DISCIPLINE POLICIES 11/05/2019
CHILD CARE PRACTICES 11/05/2019
POLICIES 11/05/2019
REGISTERING FICTITIOUS NAMES 10/28/2019
DIRECTOR'S QUALIFICATIONS 05/18/2016
SAMPLE WEEKLY MENU 11/05/2019
LINES OF ADMINISTRATIVE AUTHORITY 11/05/2019
FIRE/SAFETY INSPECTION 10/04/2021
JOB RESPONSIBILITIES 01/03/2020
SAFE SLEEP POLICY 12/11/2019
STAFF SHEET 01/03/2020
SANITATION INSPECTION 08/24/2021
LOCAL ZONING APPROVAL 12/18/2019
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 01/20/2022




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 2
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 14
StaffChildClass AgeNote
3 14 MIXED Staff: Kelli Henry, Tricia Asquith, and Kayla Stevener. Age range 4 months through 11 years. Three children under 24 months. Two 2 year old children.

 
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
Violation
 Provider Comments
Violation
Requirements for infant-toddler/preschool child medical examination reports on file were not met as evidenced by there was no medical examination report on file within 30 days of admission - the admission date(s) was/were 1-26-2020.
Licensing Rule Reference
5 CSR 25-500.122 Medical Examination Reports (2) (A) states: The provider, within thirty (30) days following the admission of each infant, toddler or preschool child, shall require a medical examination report signed by a licensed physician or registered nurse who is under the supervision of a licensed physician and completed not more than twelve (12) months prior to admission. The provider may use the department’s medical assessment form or the provider may use its own form if it contains all the information on the department’s form. The Child Medical Examination Report (Infant/Toddler/Pre-School)form, revised 2021, is incorporated by reference in this rule, as published by the Missouri Department of Elementary and Secondary Education, PO Box 480, Jefferson City, MO 65102-0480 and available by the department at https://dese.mo.gov/childhood/forms. This rule does not incorporate any subsequent amendments or additions.
Correction Required
Child medical requirements shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-500.132 Admission Policies and Procedures
Violation
 Provider Comments
Violation
A diet plan for each infant/toddler was not signed by the parent(s).
Licensing Rule Reference
5 CSR 25-500.132 Admission Policies and Procedures (8) (E) 3. states: A diet plan for each infant/toddler signed by the parent(s);
Correction Required
Caregivers shall follow each infant's feeding instructions as required.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-500.142 Nighttime Care
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