MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
MOELLER, CAROL ANN

Facility DVN
000208224

Phone
(314) 966-8988

Physical Address
1125 SIMMONS AVE
KIRKWOOD
MO 63122-1110

Owner
MOELLER, CAROL ANN

Mailing Address

Provider/Director
MOELLER, CAROL ANN

E-mail Address
CMOELLER4@ICLOUD.COM

Incorporated

Child Care Specialist
THERESA ZEHNLE

Age Range
BIRTH - 6 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 10 CHILDREN IN CARE NO MORE THAN 4 CHILDREN UNDER AGE 2 WITH 2 ADULT CAREGIVERS; UP TO 6 CHILDREN IN CARE NO MORE THAN 3 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER

Inspection Information

Date
08/30/2022

Arrival Time
3:00 PM

Departure Time
3:36 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2430127525

Document	Document-Date
SAMPLE WEEKLY MENU	04/14/1986
SAMPLE FORMS	04/14/1986
POLICIES	04/14/1986
OWNER/PROVIDER REFERENCES	04/14/1986
LOCAL FIRE DEPARTMENT NOTIFICATION	04/14/1986
DIAGRAM/OUTDOOR	04/14/1986
DIAGRAM/INDOOR	04/14/1986
DAILY SCHEDULE	04/14/1986
CHILD CARE/DISCIPLINE POLICIES	04/14/1986
ASSISTANT REFERENCES	11/07/2013
ASSISTANT APPROVAL REQUEST	11/07/2013
SAFE SLEEP POLICY	12/20/2017
DISASTER AND EMERGENCY PREPAREDNESS PLAN	07/23/2012
APPLICATION	10/18/2019
SAFETY PLAN	01/27/2021
FIRE/SAFETY INSPECTION	11/08/2021
EQUIPMENT LIST	01/10/2022
SANITATION INSPECTION	12/03/2021
ANNUAL DECLARATION	01/10/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	01/20/2022

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 1

Total Children 4

Staff	Child	Class Age	Note
1	4	MIXED	Carol Mueller, care giver, present with four children, one child is 14-months-old and one is 2-years-old and two children are 4-years-old


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 Compliance
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 Not Observed
5 CSR 25-400.155 Overlap Care of Children Not Observed
5 CSR 25-400.165 Emergency School Closings Not Observed
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 Not Observed
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