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
ELAINE S COX

Age Range
24 MONTHS - 12 YEARS

Capacity
40

Facility Type
GROUP HOME AND CENTER

Limitations

Inspection Information

Date
08/01/2022

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2428019251

Document	Document-Date
SANITATION INSPECTION	05/26/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	03/25/2021
EQUIPMENT LIST	03/08/2021
ANNUAL DECLARATION	01/15/2021
STAFF SHEET	03/26/2019
LOCAL ZONING APPROVAL	03/25/2019
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
FIRE/SAFETY INSPECTION	05/26/2022

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.