MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT

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Facility Information

Facility Name
DOUGLASS COMMUNITY SERVICES, INCORPORATED

Facility DVN
000659630

Phone
(660) 263-7421

Physical Address
707 SINNOCK
MOBERLY
MO 65270

Owner
DOUGLASS COMMUNITY SERVICES, INCORPORATED

Mailing Address
711 GRAND AVE DCS HEAD START
HANNIBAL
MO 63401

Provider/Director
BOSS, SUSAN MARIE

E-mail Address
moberlycm@douglassonline.org

Incorporated
Incorporated

Child Care Specialist
SUSAN MARIE DOUGLAS

Age Range
36 MONTHS - 5 YEARS

Capacity
60

Facility Type
GROUP HOME AND CENTER

Limitations

Inspection Information

Date
10/13/2022

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2432954021

Document	Document-Date
SAMPLE FORMS	04/13/2022
POLICIES	04/02/2008
LINES OF ADMINISTRATIVE AUTHORITY	10/06/2004
DISCIPLINE POLICIES	04/18/2008
JOB RESPONSIBILITIES	10/06/2004
DIRECTOR'S QUALIFICATIONS	10/06/2004
ARTICLES OF INCORPORATION	10/06/2004
CHILD CARE PRACTICES	04/18/2008
DAILY SCHEDULE	10/06/2004
DIAGRAM/OUTDOOR	10/06/2004
DIAGRAM/INDOOR	10/06/2004
LOCAL ZONING APPROVAL	10/06/2004
LOCAL BUILDING APPROVAL	10/06/2004
APPLICATION	04/24/2020
STAFF SHEET	07/01/2020
CERTIFICATE OF GOOD STANDING	03/02/2022
EQUIPMENT LIST	03/01/2022
SANITATION INSPECTION	11/15/2021
ANNUAL DECLARATION	03/01/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	03/01/2022
SAMPLE WEEKLY MENU	10/06/1994
FIRE/SAFETY INSPECTION	01/05/2022
DISASTER AND EMERGENCY PREPAREDNESS PLAN	04/13/2022

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.

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
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 Compliance
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