DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

CROCKER ACADEMY INC.

000467589

(573) 736-5922

324 S COMMERCIAL ST
CROCKER
MO  65452-9112

CROCKER ACADEMY INC.

PO BOX 222
CROCKER
MO  65452

ALLEN, KELI M

kelihelton@yahoo.com

Incorporated

LACEY BERENDZEN

24 MONTHS - 12 YEARS

40

GROUP HOME AND CENTER

 
Inspection Information

10/18/2022

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2430569451


DocumentDocument-Date
DISCIPLINE POLICIES 08/14/2012
REGISTERING FICTITIOUS NAMES 06/14/2012
ARTICLES OF INCORPORATION 04/27/1992
LOCAL ZONING APPROVAL 08/14/1992
LINES OF ADMINISTRATIVE AUTHORITY 08/14/1992
JOB RESPONSIBILITIES 09/02/1992
SAMPLE FORMS 06/30/2008
CHILD CARE PRACTICES 08/14/1992
SAMPLE WEEKLY MENU 08/14/1992
DAILY SCHEDULE 08/14/1992
POLICIES 08/14/1992
DIAGRAM/OUTDOOR 08/14/1992
DIAGRAM/INDOOR 08/14/1992
DIRECTOR'S QUALIFICATIONS 09/19/2019
APPLICATION 08/13/2020
STAFF SHEET 07/28/2020
EQUIPMENT LIST 05/02/2022
FIRE/SAFETY INSPECTION 10/04/2022
SANITATION INSPECTION 06/29/2022
ANNUAL DECLARATION 09/08/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 05/02/2022

Overlap Start TimeOverlap End TimeOverlap Submit Date
  3:00PM   5:00PM   6/8/2010



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
Violation
 Provider Comments
Violation
The Family Care Safety Registry check was not conducted for Keli Allen, Zoie Helton, and Kayla Busch within thirty (30) days prior to the anniversary date.
Licensing Rule Reference
5 CSR 25-500.052 Annual Requirements (2) (C) states: The child care provider shall conduct a Family Care Safety Registry check for all child care staff members within thirty (30) days prior to the anniversary date as printed on the license.
Correction Required
Required Family Care Safety Registry checks shall be conducted for all child care staff member(s) within thirty (30) days prior to the anniversary date.

Correction Verification
Submit Documentation

Compliance Date
9/12/2022
Violation
The annual fire safety inspection was not conducted.
Licensing Rule Reference
5 CSR 25-500.052 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
10/4/2022
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 10/26/21.
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
9/12/2022
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