DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT
Facility Information

SHIPLEY, KELLY J

002069827

(660) 227-3402

619 W HARRISON ST
BUTLER
MO  64730-1303

SHIPLEY, KELLY J



 

SHIPLEY, KELLY J

KJSHIPLEY@HOTMAIL.COM


CRYSTAL HEISER

BIRTH - 13 YEARS

10

FAMILY HOME

UP TO 10 CHILDREN IN CARE NO MORE THAN 2 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 6 CHILDREN IN CARE NO MORE THAN 3 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER; 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 4 CHILDREN UNDER AGE 2 WITH 2 ADULT CAREGIVERS
 
Inspection Information

09/27/2022

12:39 PM

12:39 PM

UNANNOUNCED

SUPPLEMENTAL

2431721175


DocumentDocument-Date
SAMPLE WEEKLY MENU 01/02/2008
POLICIES 01/27/2010
DIAGRAM/OUTDOOR 12/06/2007
DIAGRAM/INDOOR 12/06/2007
CHILD CARE/DISCIPLINE POLICIES 01/27/2010
DAILY SCHEDULE 12/06/2007
ASSISTANT APPROVAL REQUEST 12/14/2017
SAFE SLEEP POLICY 06/26/2018
DISASTER AND EMERGENCY PREPAREDNESS PLAN 10/01/2018
APPLICATION 10/30/2019
SANITATION INSPECTION 10/22/2021
FIRE/SAFETY INSPECTION 01/14/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 09/15/2022
ANNUAL DECLARATION 09/15/2022
EQUIPMENT LIST 09/15/2022

Overlap Start TimeOverlap End TimeOverlap Submit Date
  11:00AM   12:00PM   12/12/2019
  3:30PM   4:30PM   12/12/2019



Inspection determined facility to be in compliance with licensing rules.
Open Violations: 4
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 25-400.025 Organization and Administration
Not Observed
5 CSR 25-400.045 Licensing Process
Not Observed
5 CSR 25-400.055 Annual Requirements
Violation
 Provider Comments
Violation
The Family Care Safety Registry check was not conducted for Kelly Shipley and Teola Shipley within thirty (30) days prior to the anniversary date.
Licensing Rule Reference
5 CSR 25-400.055 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

Violation
The Annual Declaration was not submitted..
Licensing Rule Reference
5 CSR 25-400.055 Annual Requirements (1) (A) states: An Annual Declaration for Licensed Facility form, revised 2021 and 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, indicating the licensee’s intent to continue operating a licensed family child care home and agreement to comply with all statutes and department licensing rules;
Correction Required
The child care provider shall submit the Annual Declaration as required.

Correction Verification
Submit Documentation

Compliance Date
9/15/2022
Violation
The listing of household members and assistants was not submitted.
Licensing Rule Reference
5 CSR 25-400.055 Annual Requirements (1) (C) states: A listing of household members and assistant(s).
Correction Required
The child care provider shall submit a listing of all household members and assistants.

Correction Verification
Submit Documentation

Compliance Date
9/15/2022
Violation
The equipment list was not submitted.
Licensing Rule Reference
5 CSR 25-400.055 Annual Requirements (1) (B) states: A current list of available equipment.
Correction Required
The child care provider shall submit an equipment list as required.

Correction Verification
Submit Documentation

Compliance Date
9/15/2022
5 CSR 25-400.085 Physical Requirements of the Family Day Care Home
Violation
 Provider Comments
Violation
There was evidence of spiders/webs in the playroom on top and below the shelves.
Licensing Rule Reference
5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (2) (A) 9. states: The home shall be clean at all times and free of dirt, insects, spiders, rodents or other pests.
Correction Required
The facility shall be clean and pest free.

Correction Verification
Submit Documentation

Compliance Date
9/15/2022
Violation
There was evidence of dirt/debris in the window sills in the play room and dust/debris on the ceiling fan.
Licensing Rule Reference
5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (2) (A) 9. states: The home shall be clean at all times and free of dirt, insects, spiders, rodents or other pests.
Correction Required
The facility shall be clean and pest free.

Correction Verification
Submit Documentation

Compliance Date
9/15/2022
Violation
The walls located in the baby room was/were not finished with material which can be cleaned easily as evidenced by exposed particle board.
Licensing Rule Reference
5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (2) (A) 6. states: Walls, ceilings and floors shall be finished with material which can be cleaned easily and shall be free of splinters, cracks and chipping paint. Floor covering shall be in good condition. Lead-free paint shall be used for all painted surfaces.
Correction Required
Walls, ceilings, and floors shall be made of approved materials, easily cleaned and in good condition.

Correction Verification
Submit Documentation

Compliance Date
9/15/2022
Violation
The fall-zone area under and around outdoor equipment where children might fall and be injured was not covered with impact-absorbing materials to cushion a fall as evidenced by bare grass underneath the orange slide, two blue slides, the pink slide, the white slide, teeter totter, and the white climbing piece.
Licensing Rule Reference
5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (3) (A) 9. states: Concrete, asphalt, carpet or bare soil is not an acceptable surface under outdoor equipment from which children might fall and be injured.
Correction Required
The facility shall maintain approved resilient material in all fall-zone areas.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-400.086 Fire Safety
Not Observed
5 CSR 25-400.090 Disaster and Emergency Preparedness
Violation
 Provider Comments
Violation
The facility has not developed, implemented or maintained policies and procedures for responding to a disaster emergency.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (A) . states: The facility shall develop, implement, and maintain policies and procedures for responding to a disaster emergency, including a written plan for:
Correction Required
Facility must have plan on file as required.

Correction Verification
Submit Documentation

Compliance Date
9/15/2022
5 CSR 25-400.095 Furniture, Equipment and Materials
Violation
 Provider Comments
Violation
Outdoor equipment, water table, red cozy coupe, and two wagons, in the outdoor play yard was not in good condition as evidenced by broken plastic exposing sharp pieces accessible to children.
Licensing Rule Reference
5 CSR 25-400.095 Furniture, Equipment and Materials 3 (A) states: All outdoor equipment shall be constructed safely, in good condition and free of sharp, loose or pointed parts. Only lead-free paint shall be used.
Correction Required
Outdoor equipment shall have no exposed hazards.

Correction Verification
Submit Documentation

Compliance Date

Violation
The requirements for equipment to be clean, in good condition and accessible were not met as evidenced by dirt build-up on all plastic toy pieces.
Licensing Rule Reference
5 CSR 25-400.095 Furniture, Equipment and Materials 2 (A) 1 states: Play equipment and materials shall be clean, in good condition with all parts intact and accessible to children.
Correction Required
Indoor play equipment, clean and in good repair, shall be accessible to children.

Correction Verification
Submit Documentation

Compliance Date
9/15/2022
5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel
Violation
 Provider Comments
Violation
The requirements for obtaining 12 clock hours each calendar year were not met. For the calendar year of 2021, the staff listed need the following information: Kelly Shipley needs 1 clock hour.
Licensing Rule Reference
5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel (4) (A) states: The provider shall obtain at least twelve (12) clock hours of child care-related training during each calendar year. Any assistant who works or volunteers more than five (5) hours per week shall meet the same training requirements. Clock hour training shall be approved by the department.
Correction Required
Required training hours shall be documented for each caregiver.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-400.115 Child Care Family and Household
Not Observed
5 CSR 25-400.125 Medical Examination Reports
Not Observed
5 CSR 25-400.135 Admission Policies and Procedures
Not Observed
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
Not Observed
5 CSR 25-400.185 Health Care
Violation
 Provider Comments
Violation
Requirements for immunization reports on file were not met as evidenced by required immunizations verifying the type of vaccine and the month, day and year of administration was not on file for 1 child(ren).
Licensing Rule Reference
5 CSR 25-400.185 Health Care (4) (A) states: No child shall be permitted to enroll in or attend any day care facility caring for ten (10) or more children unless the child has been adequately immunized against vaccine preventable childhood illnesses specified by the department in accordance with recommendations of Immunization Practices Advisory Committee (ACIP). The parent or guardian of the child shall provide satisfactory evidence of the required immunizations. Satisfactory evidence means a statement, certificate or record from a physician or other recognized health facility or personnel, stating that the required immunizations have been given to the child and verifying the type of vaccine and the month, day and year of administration.
Correction Required
Child immunization requirements shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
9/15/2022
5 CSR 25-400.190 Nutrition and Food Service
Not Observed
5 CSR 25-400.200 Transportation and Field Trips
Not Observed
5 CSR 25-400.210 Records and Reports
Violation
 Provider Comments
Violation
1 child(ren) records did not include full name, home address, employers name and address, work schedule and home and work telephone numbers of the parent(s), guardian or legal custodian.
Licensing Rule Reference
5 CSR 25-400.210 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers’ name and address, work schedule and home and work telephone numbers.
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
9/15/2022
5 CSR 25-600.020 General Requirements
Not Observed
5 CSR 25-600.040 Background Screening Findings
Not Observed
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.
Not Observed
RSMo 210.211.  License required - exceptions - written notice of licensure status, when.
Not Observed
RSMo 210.252. Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized.
Compliance