DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

DOUGLASS COMMUNITY SERVICES, INCORPORATED

002558647

(660) 395-1455

406 BLEES INDUSTRIAL DR
MACON
MO  63552-4451

DOUGLASS COMMUNITY SERVICES, INCORPORATED

711 GRAND AVE
HANNIBAL
MO  63401

KEUNE, KIMBERLY DENISE

maconccpcm@douglassonline.org

Incorporated

BETHANY C DUCKWORTH

6 WEEKS - 35 MONTHS

16

GROUP HOME AND CENTER

 
Inspection Information

08/29/2022

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2429985512


DocumentDocument-Date
ANNUAL DECLARATION 11/22/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 11/22/2021
DIAGRAM/INDOOR 01/18/2016
SAMPLE WEEKLY MENU 01/08/2016
SAMPLE FORMS 01/08/2016
DISASTER AND EMERGENCY PREPAREDNESS PLAN 01/08/2016
ARTICLES OF INCORPORATION 09/15/2017
DAILY SCHEDULE 01/08/2016
DIAGRAM/OUTDOOR 07/11/2018
DIRECTOR'S QUALIFICATIONS 12/21/2018
JOB RESPONSIBILITIES 06/18/2018
SAFE SLEEP POLICY 05/06/2019
LINES OF ADMINISTRATIVE AUTHORITY 05/06/2019
LOCAL ZONING APPROVAL 10/28/2019
APPLICATION 10/15/2019
EQUIPMENT LIST 11/22/2021
FIRE/SAFETY INSPECTION 12/02/2021
DISCIPLINE POLICIES 11/12/2019
POLICIES 11/12/2019
STAFF SHEET 10/28/2019
CHILD CARE PRACTICES 11/12/2019
CERTIFICATE OF GOOD STANDING 11/22/2021
SANITATION INSPECTION 10/29/2021




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.

 
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 5-23-2022.
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
8/23/2022
5 CSR 25-500.132 Admission Policies and Procedures
Compliance
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