DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

WAVERLY FOREST ACADEMY, LLC

002140516

(636) 940-0550

3545 FRANKS DR
ST CHARLES
MO  63301-4041

WAVERLY FOREST ACADEMY, LLC



 

ELMENDORF, LEANNE MICHELLE

INFO@WAVERLYFOREST.COM


KATHERINE D SIMS

6 WEEKS - 12 YEARS

93

GROUP HOME AND CENTER

9 CHILDREN UNDER 12 MONTHS; 25 CHILDREN UNDER 24 MONTHS
 
Inspection Information

10/05/2022

8:20 AM

8:59 AM

UNANNOUNCED

REINSPECTION

2432278964


DocumentDocument-Date
SAMPLE WEEKLY MENU 03/10/2009
POLICIES 03/10/2009
LINES OF ADMINISTRATIVE AUTHORITY 03/10/2009
JOB RESPONSIBILITIES 03/10/2009
DISCIPLINE POLICIES 03/10/2009
DAILY SCHEDULE 03/10/2009
CHILD CARE PRACTICES 03/10/2009
DIRECTOR'S QUALIFICATIONS 03/23/2009
SAMPLE FORMS 03/19/2009
DIAGRAM/OUTDOOR 03/10/2009
DIAGRAM/INDOOR 03/10/2009
LOCAL ZONING APPROVAL 03/19/2009
LLC OPERATING AGREEMENT 03/10/2009
LLC ARTICLES OF ORGANIZATION 03/10/2009
LOCAL BUILDING APPROVAL 01/11/2017
LOCAL FIRE DEPARTMENT NOTIFICATION 03/10/2009
SAFE SLEEP POLICY 10/22/2018
CERTIFICATE OF GOOD STANDING 01/17/2019
APPLICATION 10/23/2018
DISASTER AND EMERGENCY PREPAREDNESS PLAN 01/02/2019
STAFF SHEET 01/18/2019
EQUIPMENT LIST 02/10/2022
SANITATION INSPECTION 12/16/2021
FIRE/SAFETY INSPECTION 01/10/2022
ANNUAL DECLARATION 02/14/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 03/15/2022




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 6
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 8
Total Children 32
StaffChildClass AgeNote
3 8 INFANTS AND TODDLERS Caregivers, T.S., B.B., and E.C. present with eight children, ages 12-months-old to 18-months-old
1 4 INFANTS AND TODDLERS Caregiver, S.S present with four children, ages 5-months-old to 13-months-old
1 0 NO CHILDREN IN ATTENDANCE Director L.E. present with no children in attendance
1 8 PRESCHOOL Caregiver, T.M. present with eight children, ages 3-years-old to 4-years-old
1 5 PRESCHOOL Caregiver, K.P. present with five children, all 4-years-old
1 7 TWO YEAR OLDS Caregiver, E.R. present with seven children, all 2-years-old

 
5 CSR 25-500.032 Organization and Administration
Not Observed
5 CSR 25-500.042 Licensing Process
Not Observed
5 CSR 25-500.052 Annual Requirements
Not Observed
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers
Violation
 Provider Comments
Violation
The walls located in the 2-years-old classroom was/were not in good condition as evidenced by there were multiple areas of peeling paint at the baseboard near the carpet area.
Licensing Rule Reference
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (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

Violation
The walls located in the toddler classroom near the "learn" wall was/were not in good condition as evidenced by there were multiple areas of peeling paint.
Licensing Rule Reference
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (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

Violation
The walls located in between the toddler rooms was/were not in good condition as evidenced by there was a rectangular chunk of drywall missing.
Licensing Rule Reference
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (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

5 CSR 25-500.087 Fire Safety
Not Observed
5 CSR 25-500.090 Disaster and Emergency Preparedness
Not Observed
5 CSR 25-500.092 Furniture, Equipment and Materials
Violation
 Provider Comments
Violation
Furniture/equipment, blue couch, in the 2-year-old classroom was not in good condition as evidenced by the front of the couch was frayed and flakey.
Licensing Rule Reference
5 CSR 25-500.092 Furniture, Equipment and Materials (1) (A) 1. states: All furniture and 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
The facility shall provide safe and clean furniture/equipment as required.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-500.102 Personnel
Violation
 Provider Comments
Violation
K.P. and T.M. did not complete safe sleep training within 30 days of employment or volunteering at the facility.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (4) (C) states: The center director, group child care home provider, all other caregivers, and those volunteers who are counted in staff/child ratios shall complete safe sleep training described in section (4) of this rule within thirty (30) days of employment or volunteering at the facility.
Correction Required
The department approved safe sleep training must be completed within 30 days of employment or volunteering.

Correction Verification
Return Inspection

Compliance Date
10/5/2022
Violation
Verification of safe sleep training was not documented and maintained as evidenced by K.P. and T.M. have completed safe sleep, but it is not yet documented on the facility toolbox.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (4) (A) states: The training shall be documented and maintained as described in paragraph (3)(F)2. of this rule.
Correction Required
Safe sleep training shall be documented and maintained.

Correction Verification
Submit Documentation

Compliance Date

Violation
Safe sleep training was not completed within the past 3 years for the following staff A.N..
Licensing Rule Reference
5 CSR 25-500.102 Personnel (4) . states: Safe Sleep Training. Every three (3) years the center director, group child care home provider, all other caregivers, and those volunteers who are counted in staff/child ratios in a group child care home or child care center licensed to provide care for infants less than one (1) year of age shall successfully complete department-approved training regarding the American Academy of Pediatrics (AAP) safe sleep recommendations contained in the American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome. Technical report – SIDS and other sleep-related infant deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment, by Moon RY, which is incorporated by reference in this rule as published in PEDIATRICS Volume 138, No. 5, November 1, 2016 and available at http://pediatrics.aappublications.org/content/pediatrics/early/2016/10/20/peds.2016-2938.full.pdf. This rule does not incorporate any subsequent amendments or additions.
Correction Required
The director, group home provider, other caregivers, and those volunteers counted in staff/child ratio, shall complete department approved safe sleep training as required.

Correction Verification
Return Inspection

Compliance Date
10/5/2022
5 CSR 25-500.112 Staff/Child Ratios
Violation
 Provider Comments
Violation
Staff/child ratio requirements were not met as evidenced by 15 children, ages 1-year-old to 2-years-old, were cared for by 3 caregiver(s).
Licensing Rule Reference
5 CSR 25-500.112 Staff/Child Ratios (1) (A) states: Birth Through Two (2) Years. Groups composed of mixed ages through two (2)- years shall have no less than one (1) adult to four (4) children, with no more than eight (8) children in a group;
Correction Required
Correct staff/child ratios and group size shall be maintained.

Correction Verification
Return Inspection

Compliance Date
10/5/2022
5 CSR 25-500.122 Medical Examination Reports
Violation
 Provider Comments
Violation
The medical examination report on file was older than 12 months before the individual's begin date at the facility.
Licensing Rule Reference
5 CSR 25-500.122 Medical Examination Reports (1) (C) states: Medical examination reports shall be completed not more than twelve (12) months prior to beginning work in the facility and may be transferable to another child care facility for subsequent employment.
Correction Required
Medical reports shall be on file as required.

Correction Verification
Return Inspection

Compliance Date
10/5/2022
Violation
A medical examination report included either a Risk Assessment for Tuberculosis form or a negative tuberculin skin test (TST) which was completed more than 12 months before beginning work in the facility for the following staff: K.P..
Licensing Rule Reference
5 CSR 25-500.122 Medical Examination Reports (1) (B) . states: Medical examination reports shall include either a Tuberculosis (TB) Risk Assessment form, completed and signed by a health care professional, or a negative tuberculin skin test (TST) completed not more than twelve (12) months before beginning work in the facility. The Tuberculosis (TB) Risk Assessment form, revised March 2014, is incorporated by reference in this rule, as published by the Missouri Department of Health and Senior Services, PO Box 570, Jefferson City, MO 65102 and available by the Missouri Department of Health and Senior Services at https://health.mo.gov/living/healthcondiseases/communicable/tuberculosis/tbmanual/pdf/RiskAssessmentform.pdf. If the person has signs or symptoms of tuberculosis, or risk factors for tuberculosis, then testing for tuberculosis shall occur.
Correction Required
Medical examination reports shall include Risk Assessment for Tuberculosis forms or negative tuberulin skin test (TST) as required.

Correction Verification
Submit Documentation

Compliance Date
9/30/2022
Violation
Medical examination report form did not contain all required information as evidenced by J.S., E.R.,, and S.L. all need the yes/no box completed on the medical exams.
Licensing Rule Reference
5 CSR 25-500.122 Medical Examination Reports (1) (D) states: The medical examination report form shall be supplied by the department or the facility may use its own form if it contains all the information on the department’s form. The Medical Examination Report for Caregivers and Staff 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
Medical reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date
9/30/2022
5 CSR 25-500.132 Admission Policies and Procedures
Violation
 Provider Comments
Violation
The facility did not meet requirements for child enrollment and health information as evidenced by Child F needs authorization for emergency medical care complete to show Waverly Forest.
Licensing Rule Reference
5 CSR 25-500.132 Admission Policies and Procedures (8) (E) 4. states: Instructions for action to be taken if the parent(s) or physician designated by the parent(s) cannot be reached in an emergency and permission for emergency medical care;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Return Inspection

Compliance Date
10/5/2022
5 CSR 25-500.142 Nighttime Care
Not Observed
5 CSR 25-500.162 Overlap Care of Children
Not Observed
5 CSR 25-500.172 Emergency School Closings
Not Observed
5 CSR 25-500.182 Child Care Program
Not Observed
5 CSR 25-500.192 Health Care
Not Observed
5 CSR 25-500.202 Nutrition and Food Service
Violation
 Provider Comments
Violation
The provider did not meet requirements for a written diet plan for each infant and toddler as evidenced by the written diet plan was not updated for a child in that Child C needs the 12-23 month section completed.
Licensing Rule Reference
5 CSR 25-500.202 Nutrition and Food Service (2) (B) states: The written diet plan for each infant/toddler shall be followed. The parent(s) shall update the plan according to the individual needs of the child until they grant permission in writing for the child to eat table foods.
Correction Required
A written diet plan shall be on file for each infant/toddler, updated as needed and followed by caregivers.

Correction Verification
Submit Documentation

Compliance Date
9/30/2022
5 CSR 25-500.212 Transportation and Field Trips
Not Observed
5 CSR 25-500.222 Records and Reports
Violation
 Provider Comments
Violation
1 child(ren) records did not include work telephone number of parent(s), guardian or legal custodian.
Licensing Rule Reference
5 CSR 25-500.222 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
9/30/2022
5 CSR 25-600.020 General Requirements
Violation
 Provider Comments
Violation
Criminal background check results were not on file for T.M. and M.S..
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

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