MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
MICKELSON, KRISTINA LYNN

Facility DVN
001838177

Phone
(573) 202-9925

Physical Address
11075 WOODALE DR
ROLLA
MO 65401

Owner
MICKELSON, KRISTINA LYNN

Mailing Address

Provider/Director
MICKELSON, KRISTINA LYNN

E-mail Address
krissmickelson75@gmail.com

Incorporated

Child Care Specialist
THERESA BINKLEY

Age Range
BIRTH - 13 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
09/06/2022

Arrival Time
8:45 AM

Departure Time
10:38 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2430496683

Document	Document-Date
OWNER/PROVIDER REFERENCES	02/23/2004
SAMPLE WEEKLY MENU	05/05/2004
SAMPLE FORMS	02/02/2004
DAILY SCHEDULE	02/02/2004
CHILD CARE/DISCIPLINE POLICIES	02/02/2004
POLICIES	02/02/2004
DIAGRAM/OUTDOOR	07/30/2004
DIAGRAM/INDOOR	07/30/2004
ASSISTANT APPROVAL REQUEST	05/25/2010
APPLICATION	08/18/2020
EQUIPMENT LIST	08/04/2022
FIRE/SAFETY INSPECTION	07/21/2021
SANITATION INSPECTION	07/13/2021
ANNUAL DECLARATION	08/04/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	08/04/2022

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 1

Total Children 9

Staff	Child	Class Age	Note
1	9	INFANTS AND TODDLERS	Kristina Mickelson with Nine children. One child is 3 months old, One child is 1 years old, Two children are 2 years old,Two children age 3 years old, and Three children age 4 years old.