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.

Compliance List

5 CSR 25-400.025 Organization and Administration

Compliance

5 CSR 25-400.045 Licensing Process

Compliance

5 CSR 25-400.055 Annual Requirements

Violation

	Provider Comments
Violation The annual sanitation inspection was not approved. Licensing Rule Reference 5 CSR 25-400.055 Annual Requirements (2) (B) states: Evidence of compliance with local, state, or both, sanitation requirements. Correction Required The facility shall submit evidence of compliance with annual sanitation requirements. Correction Verification Submit Documentation Compliance Date
Violation The annual fire safety inspection was not conducted. Licensing Rule Reference 5 CSR 25-400.055 Annual Requirements (2) (A) states: Evidence of compliance with a fire and safety inspection as conducted by the State Fire Marshal or his/her designee. Correction Required The facility shall submit evidence of compliance with annual fire safety requirements. Correction Verification Submit Documentation Compliance Date

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

Compliance

5 CSR 25-400.155 Overlap Care of Children

Compliance

5 CSR 25-400.165 Emergency School Closings

Compliance

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

Compliance

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