MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT

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Facility Information

Facility Name
THE CRAYON ACADEMY, LLC

Facility DVN
002751900

Phone
(417) 362-9287

Physical Address
122 S JACKSON ST
MOUNTAIN VIEW
MO 65548-7410

Owner
THE CRAYON ACADEMY, LLC

Mailing Address
5518 S KIMBROUGH AVE
SPRINGFIELD
MO 65810-2730

Provider/Director
SOUTHWORTH, CAITLYN NICOLE

E-mail Address
HEATHERDEANN6@GMAIL.COM

Incorporated

Child Care Specialist
ELAINE S COX

Age Range
24 MONTHS - 12 YEARS

Capacity
40

Facility Type
GROUP HOME AND CENTER

Limitations

Inspection Information

Date
11/04/2022

Arrival Time
10:42 AM

Departure Time
11:54 AM

Notice
UNANNOUNCED

Inspection Type
CLOSE SUPERVISION

Inspection ID
2434705171

Document	Document-Date
SANITATION INSPECTION	05/26/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	03/25/2021
EQUIPMENT LIST	03/08/2021
ANNUAL DECLARATION	01/15/2021
STAFF SHEET	03/26/2019
LOCAL ZONING APPROVAL	03/25/2019
APPLICATION	12/31/2018
DIAGRAM/INDOOR	02/13/2019
DIAGRAM/OUTDOOR	02/13/2019
DISASTER AND EMERGENCY PREPAREDNESS PLAN	02/13/2019
OWNER/PROVIDER REFERENCES	02/13/2019
LLC ARTICLES OF ORGANIZATION	01/15/2019
DAILY SCHEDULE	03/13/2019
LOCAL FIRE DEPARTMENT NOTIFICATION	03/04/2019
LINES OF ADMINISTRATIVE AUTHORITY	03/13/2019
LLC OPERATING AGREEMENT	03/13/2019
CHILD CARE PRACTICES	03/13/2019
DISCIPLINE POLICIES	03/13/2019
POLICIES	03/13/2019
JOB RESPONSIBILITIES	03/15/2019
SAMPLE WEEKLY MENU	03/15/2019
DIRECTOR'S QUALIFICATIONS	03/22/2019
FIRE/SAFETY INSPECTION	05/26/2022

Overlap Start Time	Overlap End Time	Overlap Submit Date
3:30PM	4:30PM	4/6/2020
7:30AM	8:30AM	4/6/2020

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.

Attendance at Time of Inspection

Total Staff 4

Total Children 17

Staff	Child	Class Age	Note
4	17	MIXED	BR and MH outside with 17 children ages 2-years-old to 4-years-old. This includes 1- 2 year old child. During inspection CS and SV went outside to relieve BR as she came in the building to cook lunch.