DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

SHELBY'S PLAY AND LEARN CHILDCARE LLC

002938496

(660) 438-4003

1018 REDBUD DR.
WARSAW
MO  65355

SHELBY'S PLAY AND LEARN CHILDCARE LLC

33987 YODER AVE
WARSAW
MO  65355-5237

SLOAN, SHELBY ANN

Shelby.Sloan22@icloud.com


LACEY BERENDZEN

BIRTH - 12 YEARS

60

GROUP HOME AND CENTER

24 CHILDREN IN THE INFANT/TODDLER UNIT
 
Inspection Information

10/06/2022

1:00 PM

4:55 PM

UNANNOUNCED

POST LICENSING

2432493712


DocumentDocument-Date
DIRECTOR'S QUALIFICATIONS 05/19/2022
DIAGRAM/OUTDOOR 06/15/2022
DIAGRAM/INDOOR 06/15/2022
DAILY SCHEDULE 06/05/2022
CHILD CARE PRACTICES 06/05/2022
CERTIFICATE OF GOOD STANDING 01/28/2022
APPLICATION 01/28/2022
DISASTER AND EMERGENCY PREPAREDNESS PLAN 06/05/2022
DISCIPLINE POLICIES 06/05/2022
JOB RESPONSIBILITIES 04/22/2022
LINES OF ADMINISTRATIVE AUTHORITY 05/03/2022
LLC OPERATING AGREEMENT 05/04/2022
LLC ARTICLES OF ORGANIZATION 01/28/2022
LOCAL BUILDING APPROVAL 04/28/2022
LOCAL FIRE DEPARTMENT NOTIFICATION 04/22/2022
LOCAL ZONING APPROVAL 04/28/2022
POLICIES 06/05/2022
REGISTERING FICTITIOUS NAMES 01/27/2022
SAMPLE FORMS 06/16/2022
EQUIPMENT LIST 04/18/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 04/14/2022
SAMPLE WEEKLY MENU 04/14/2022
SAFE SLEEP POLICY 06/05/2022
FIRE/SAFETY INSPECTION 04/27/2022
LICENSING ORIENTATION 01/27/2022
SANITATION INSPECTION 04/19/2022

Overlap Start TimeOverlap End TimeOverlap Submit Date
  3:30PM   4:30PM   7/14/2022
  6:30AM   7:30AM   7/14/2022



Inspection determined facility to be in compliance with licensing rules.
Compliance Licensing Rules
Open Violations: 13
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 10
Total Children 37
StaffChildClass AgeNote
2 6 INFANTS AND TODDLERS MF and AP with 6 infants. Children age 4 months - 11 months old.
1 4 INFANTS AND TODDLERS KP with 4 children, all children age 1 year old.
1 4 INFANTS AND TODDLERS CM with 4 children, all children age 1 year old.
1 0 NO CHILDREN IN ATTENDANCE JG in kitchen.
1 0 NO CHILDREN IN ATTENDANCE SS - no children in office/assisting inspector after AP entered the infant classroom at 1:05 PM
2 12 PRESCHOOL BF and MU with 12 children. Eight children were 2 years old and four children were 3 years old.
2 11 PRESCHOOL BT and BA with 11 children. Children were 3-5 years old.

Compliance List
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
Violation
 Provider Comments
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 no resilient material was present.
Licensing Rule Reference
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (6) (A) 5. states: The fall-zone area under and around outdoor equipment where children might fall and be injured shall be covered with impact absorbing materials which will effectively cushion the fall of a child. This material may include sand, pea gravel, tanbark, shredded tires, wood chips, rubber matting or other approved resilient material.
Correction Required
The facility shall maintain approved resilient material in all fall-zone areas.

Correction Verification
Submit Documentation

Compliance Date

Violation
Diapering requirements were not met as evidenced by the diapering table was not located where caregiver could maintain supervision of his/her group of children. The diapering table was located in the middle infant room, the pad was moved on top of the counter next to the sink, the free standing table was pushed against the wall.
Licensing Rule Reference
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (4) (A) states: A safe diapering table with a waterproof washable surface shall be used for changing diapers. The diapering table shall be located within or adjacent to the group space so the caregiver using the diapering table can maintain supervision of his/her group of children at all times.
Correction Required
The facility shall provide a safe and clean diapering table as required.

Correction Verification
Corrected on Site

Compliance Date
10/6/2022
Violation
The floors located in 2 year old room was/were not finished with material which can be cleaned easily as evidenced by the rubber sealant used is visibly dirty and is beginning to peel.
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 premises were not safe and suitable as evidenced by the blinds in the pre-k room were broken in several places.
Licensing Rule Reference
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (A) states: The premises shall be safe and suitable for the care of children.
Correction Required
The premises shall be safe and suitable for the care of children.

Correction Verification
Corrected on Site

Compliance Date
10/6/2022
Violation
The walls located in girls bathroom in the pre-k room was/were not in good condition as evidenced by there is a hold behind the doorknob that measured 3.5 inches exposing the inside wall.
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
Compliance
5 CSR 25-500.090 Disaster and Emergency Preparedness
Compliance
5 CSR 25-500.092 Furniture, Equipment and Materials
Violation
 Provider Comments
Violation
Sleeping equipment was not arranged to provide required spacing as evidenced by the aisle on the long side of the napping equipment was too narrow - the space measured 20 inches.
Licensing Rule Reference
5 CSR 25-500.092 Furniture, Equipment and Materials (1) (B) 1. D. states: Sleeping equipment shall be arranged to provide at least a two foot (2') aisle on one (1) long side of the equipment.
Correction Required
Caregivers shall provide a two foot (2') aisle on one long side of the napping equipment.

Correction Verification
Corrected on Site

Compliance Date
10/6/2022
Violation
A child was on a cot; no parental permission was on file.
Licensing Rule Reference
5 CSR 25-500.092 Furniture, Equipment and Materials (1) (B) 2. B. states: With written parental consent on file, cots may be used for napping or sleeping for toddlers twelve (12) months and older.
Correction Required
The facility shall use cots for toddlers only with written parental permission.

Correction Verification
Submit Documentation

Compliance Date

Violation
Requirements for the crib mattress/playpen padding/bedding were not met as evidenced by bedding was soiled/wet.
Licensing Rule Reference
5 CSR 25-500.092 Furniture, Equipment and Materials (1) (B) 2. D. states: The crib mattress or playpen pad shall be sized correctly to the crib or playpen, in good condition, waterproof and kept clean and dry, be firm and maintain its shape even when the fitted sheet designated for that model is used, such that there are no gaps between the mattress and the side of the crib or playpen. Only fitted sheets shall be used. Only fitted sheet shall be used and shall be changed immediately when soiled or wet.
Correction Required
Sleeping equipment shall meet safety and sanitation requirements.

Correction Verification
Corrected on Site

Compliance Date
10/6/2022
5 CSR 25-500.102 Personnel
Violation
 Provider Comments
Violation
The facility did not conduct a Family Care Safety Registry screening for AR, who was hired on 7/18/22.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (1) (P) states: The child care provider shall conduct a Family Care Safety Registry screening prior to employment for any newly hired child care staff member who has a qualifying criminal background check result.
Correction Required
Required results of the Family Care Safety Registry screening shall be on file.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-500.112 Staff/Child Ratios
Compliance
5 CSR 25-500.122 Medical Examination Reports
Violation
 Provider Comments
Violation
A medical examination report did not include either a Risk Assessment for Tuberculosis form or a negative tuberculin skin test (TST) for the following staff: KT.
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

5 CSR 25-500.132 Admission Policies and Procedures
Violation
 Provider Comments
Violation
An individualized plan for specialized care for a child with special physical, developmental or behavioral needs was not on file.
Licensing Rule Reference
5 CSR 25-500.132 Admission Policies and Procedures (6) states: A child who has a special physical, developmental or behavioral need shall have on file an individualized plan for specialized care from a professionally qualified source.
Correction Required
An individualized plan from a professional source shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

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
Violation
 Provider Comments
Violation
2 child(ren) records did not include work schedule 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

Violation
1 child(ren) records did not include address of another individual who might be reached in an emergency.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (C) states: Name, address and telephone number of another individual (friend or relative) who might be reached in an emergency when the parent(s), guardian or legal custodian cannot be reached;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
2 child(ren) records did not include telephone number of family physician or hospital.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (D) states: Name and phone number of the family physician, hospital, or both, to be used in an emergency;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Corrected on Site

Compliance Date
10/6/2022
Violation
2 child(ren) records did not include field trip and transportation authorization.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (F) states: Field trip and transportation authorization.
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
1 child(ren) records did not include employers' name 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

Violation
2 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

Violation
2 child(ren) records did not include employers' address 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

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