DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

SHALOM CHRISTIAN ACADEMY & DAYCARE

001802053

(573) 256-4824

312 RIDGEWAY AVE
COLUMBIA
MO  65203-2624

SHALOM CHRISTIAN ACADEMY & DAYCARE

PO BOX 901
COLUMBIA
MO  65205-0901

FONVILLE, ELAINE

Sca6903@mediacombb.net

Incorporated

JOY LYNN NICHOLS

BIRTH - 12 YEARS

48

GROUP HOME AND CENTER

18 CHILDREN UNDER 24 MONTHS
 
Inspection Information

09/30/2022

11:00 AM

12:00 PM

UNANNOUNCED

CLOSE SUPERVISION

2432093262


DocumentDocument-Date
DIRECTOR'S QUALIFICATIONS 02/02/2016
JOB RESPONSIBILITIES 02/02/2016
LOCAL FIRE DEPARTMENT NOTIFICATION 02/02/2016
LOCAL ZONING APPROVAL 02/02/2016
LOCAL BUILDING APPROVAL 02/02/2016
SAMPLE WEEKLY MENU 02/02/2016
DISCIPLINE POLICIES 02/02/2016
ARTICLES OF INCORPORATION 01/11/2016
CERTIFICATE OF GOOD STANDING 01/11/2016
STAFF SHEET 01/11/2016
LINES OF ADMINISTRATIVE AUTHORITY 01/11/2016
DAILY SCHEDULE 02/02/2016
DIAGRAM/INDOOR 07/06/2015
DIAGRAM/OUTDOOR 07/06/2015
CHILD CARE PRACTICES 02/03/2016
POLICIES 02/03/2016
APPLICATION 11/17/2019
EQUIPMENT LIST 01/31/2022
FIRE/SAFETY INSPECTION 01/25/2022
SANITATION INSPECTION 12/09/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 01/31/2022
ANNUAL DECLARATION 01/31/2022

Overlap Start TimeOverlap End TimeOverlap Submit Date
  2:30PM   4:30PM   4/28/2022



Inspection determined facility to be in compliance with licensing rules.
Open Violations: 3
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 6
Total Children 30
StaffChildClass AgeNote
1 4 INFANTS AND TODDLERS children ages 3 months to 12 months; Jamin Hardin
2 8 INFANTS AND TODDLERS children ages 12 months to 23 months; Janet Logan and Gariana Davidson
1 0 NO CHILDREN IN ATTENDANCE John Fonville, facility owner
1 10 PRESCHOOL children ages three and four; Marilyn Cook
1 8 TWO YEAR OLDS Elaine Fonville

 
5 CSR 25-500.032 Organization and Administration
Compliance
5 CSR 25-500.042 Licensing Process
Compliance
5 CSR 25-500.052 Annual Requirements
Compliance
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 6/15/22.
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

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 5/18/22.
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

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
Violation
 Provider Comments
Violation
Requirements for immunization reports on file were not met as evidenced by one immunization record(s) was/were not on file.
Licensing Rule Reference
5 CSR 25-500.192 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 immunized adequately against vaccine preventable childhood illnesses specified by the department in accordance with recommendations of the 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 on file as required.

Correction Verification
Submit Documentation

Compliance Date

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
Violation
 Provider Comments
Violation
Criminal background check results were not on file for Mya Fristoe.
Licensing Rule Reference
5 CSR 25-600.020 General Requirements (1) states: Prior to the employment or presence of a child care staff member in a licensed, regulated, or registered child care facility not exempted by section 210.1080.13, RSMo, the child care provider shall request the results of a criminal background check for such child care staff member from the department.
Correction Required
Required results of criminal background checks shall be on file.

Correction Verification
Submit Documentation

Compliance Date
9/30/2022
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