DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

LITTLE MIRACLES LEARNING CENTER

002481872

(573) 846-5028

17 SYCAMORE RD
PERRYVILLE
MO  63775-1210

PAISLEY, CHRISTINA



 


littlemiracles17@gmail.com


SARAH L THACKER

BIRTH - 12 YEARS

99

GROUP HOME AND CENTER

8 CHILDREN UNDER 12 MONTHS; 24 CHILDREN UNDER 24 MONTHS
 
Inspection Information

12/07/2022

10:47 AM

12:30 PM

UNANNOUNCED

REINSPECTION

2436738338


DocumentDocument-Date
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 08/08/2022
REGISTERING FICTITIOUS NAMES 06/25/2014
POLICIES 08/13/2014
LOCAL ZONING APPROVAL 08/13/2014
DISCIPLINE POLICIES 08/12/2014
SAMPLE WEEKLY MENU 08/12/2014
DIAGRAM/OUTDOOR 08/12/2014
DIAGRAM/INDOOR 08/12/2014
DAILY SCHEDULE 08/12/2014
OWNER/PROVIDER REFERENCES 08/15/2014
DIRECTOR'S QUALIFICATIONS 08/15/2014
CHILD CARE PRACTICES 08/15/2014
JOB RESPONSIBILITIES 01/04/2016
LOCAL FIRE DEPARTMENT NOTIFICATION 01/04/2016
LINES OF ADMINISTRATIVE AUTHORITY 08/13/2014
EQUIPMENT LIST 12/07/2022
STAFF SHEET 06/04/2018
APPLICATION 06/25/2018
SANITATION INSPECTION 07/26/2022
FIRE/SAFETY INSPECTION 04/19/2022
ANNUAL DECLARATION 08/08/2022




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 18
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 11
Total Children 37
StaffChildClass AgeNote
2 8 INFANTS AND TODDLERS Caregivers MP and DT with children ages 5 months to 13 months.
2 7 INFANTS AND TODDLERS Caregivers LS and DM with children ages 13 months to 23 months.
1 3 INFANTS AND TODDLERS Caregiver ND with children ages 15 months to 23 months.
1 3 MIXED Caregiver BP with children ages 2 to 3.
1 10 MIXED Caregiver SW with 4 children 2 years of age and 6 children 3 years of age.
3 0 NO CHILDREN IN ATTENDANCE Additional staff on the premises not counted in ratio include RB, CP (Director) and MP.
1 6 PRESCHOOL Caregiver RN with children ages 3 to 4.

 
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
Violation
 Provider Comments
Violation
The equipment list was not submitted.
Licensing Rule Reference
5 CSR 25-500.052 Annual Requirements (1) (C) states: A current list of available equipment.
Correction Required
The facility shall submit an equipment list as required.

Correction Verification
Submit Documentation

Compliance Date
12/7/2022
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers
Violation
 Provider Comments
Violation
The premises were not safe and suitable as evidenced by the I/T Unit 3 door is not functioning properly. The door will not shut/latch.
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
Return Inspection

Compliance Date
12/7/2022
Violation
The premises were not safe and suitable as evidenced by on 8/5/2022, around 3:20 pm, Kendra Brewer was in a classroom with eight children. A few children were sitting/playing on the cots. The cots were stacked approximately 3 feet high and were located behind the desk. Kendra observed the children on the cots. Kendra was picking up shoes located near the cots, when a child climbed onto the cots. Kendra walked away from the cots. One child was helping another child off of the cots. In the process, the cots moved away from the wall, causing a two year old child to fall onto the ground. When this occurred, Kendra looked at the cot area. Kendra continued doing what she was doing. The two year old child approached Kendra. The child had blood on her face and clothes. Kendra picked the child up and ran out of the room. Seven children were left in the room unattended for 23 to 25 seconds. Video footage was observed. During the inspection on 12/7/2022 the Director stated that the employee was terminated 8/9/2022.
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
Return Inspection

Compliance Date
12/7/2022
Violation
The premises were not safe and suitable as evidenced by trim located around the half door was missing. Four nails were exposed. This half door leads into the office area.
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
Return Inspection

Compliance Date

Violation
The premises were not safe and suitable as evidenced by the exit door from the pre-k room to the outdoor play area was missing the black protective cover, located on the push bar. One exposed screw is located where the cover was missing.
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
Return Inspection

Compliance Date

Violation
The premises were not safe and suitable as evidenced by one window was cracked on the bottom-right corner. This window is for the pre-k room. Children have access to the crack, from the outdoor play area.
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
Return Inspection

Compliance Date

Violation
The premises were not safe and suitable as evidenced by one wall air return vent, located in the two year old room was not fully secure. In addition, a gap was located between the bottom of the vent and the vent frame .
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
Return Inspection

Compliance Date
12/7/2022
Violation
The premises were not safe and suitable as evidenced by a tv in the two year old room and in the blue preschool room were not secure.
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
Return Inspection

Compliance Date
12/7/2022
Violation
The premises were not safe and suitable as evidenced by one water fountain located in the school age area was not in good condition. A small section, located on the right side of the water fountain was missing resulting in sharp edges.
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
Return Inspection

Compliance Date

Violation
The premises were not safe and suitable as evidenced by one cord in the three year old room was not secure.
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
Return Inspection

Compliance Date
12/7/2022
Violation
The walls located in the school age room was/were not in good condition as evidenced by a small hole was located in the wall. Sheetrock was exposed. This was located behind the chairs. A small hole was located along the baseboard. This was located to the right of the purple door.
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
Return Inspection

Compliance Date

Violation
The walls located in the I/T Unit 2 was/were not in good condition as evidenced by the paint was chipped off the wall, exposing the brown sheetrock paper. This was located near the half door.
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
Return Inspection

Compliance Date

Violation
The walls located in the two year old room was/were not finished with material which can be cleaned easily as evidenced by a hole was located in the wall. This was located under the diaper changing table. As of 8/8/22, the wall was patched but not painted.
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
Return Inspection

Compliance Date

Violation
The floors located in the girls restroom was/were not in good condition as evidenced by one tile located near the broken toilet was cracked.
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
Return Inspection

Compliance Date

Violation
There was no pad or mat under indoor equipment, a loft is 28 inches to 52 inches high and is located in the three year old room.
Licensing Rule Reference
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (2) (A) 8. states: Floor surfaces under indoor equipment over twenty-four inches (24") in height, from which children might fall and be injured, shall be protected with pads or mats which will effectively cushion the fall of a child. Carpeting alone is not an acceptable resilient surface under indoor equipment.
Correction Required
Pads or mats shall be in place as required.

Correction Verification
Return Inspection

Compliance Date

Violation
There was evidence of dirt/debris in hallway, school age room, girls restroom and boys restroom. This was located along the baseboards. As of 2/10/22, dirt/debris was not located in the girls restroom or boys restroom. Evidence of dirt/debris was located along the baseboards in the I/T Unit and hallway. As of 8/8/22, dirt/debris was located in the I/T Unit, school age room, girls restroom and boys restroom. Spider webs were located near the exit door in the I/T Unit and blue preschool room. The spider webs were corrected on site.
Licensing Rule Reference
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (2) (A) 9. states: The facility shall be clean at all times and free of dirt, insects, spiders, rodents or other pests.
Correction Required
The facility shall be clean and pest free.

Correction Verification
Return Inspection

Compliance Date

Violation
The facility's outdoor space was not safe for children's activities as evidenced by one pvc pipe, covering the gutter was cracked. This was located on the preschool/school age play area .
Licensing Rule Reference
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (6) (A) 4. states: The play area shall be safe for children's activities, well-maintained, free of hazards such as poisonous plants, broken glass, rocks or other debris and shall have good drainage.
Correction Required
The outdoor play area shall be clean, safe and well-maintained as required.

Correction Verification
Return Inspection

Compliance Date

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 the resilient material used is unapproved in that grass was showing through the resilient material. This was located on the I/T Unit play area.
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
Return Inspection

Compliance Date
12/7/2022
5 CSR 25-500.087 Fire Safety
Violation
 Provider Comments
Violation
Requirements of 19 CSR 30-62.087 Fire Safety were not met as evidenced by the disaster and tornado drill was not held at least one time every three months.
Licensing Rule Reference
5 CSR 25-500.087 Fire Safety (2) (F) states: Child care staff shall conduct at least one (1) fire drill each month and a disaster drill at least every three (3) months. The disaster drills shall include tornado drills. The provider shall maintain a written record at the facility of the date, type of drill, time required to evacuate the building, and number of children present during the drill.
Correction Required
Fire, tornado, and other disaster drills shall be completed and recorded as required.

Correction Verification
Return Inspection

Compliance Date
12/7/2022
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, one high chair, in I/T Unit 2 was not in good condition as evidenced by the high chair was not stable. A metal prong was located on the bottom of one high chair leg.
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
Return Inspection

Compliance Date

Violation
Furniture/equipment, grocery stand, in the three year old room was not in good condition as evidenced by two anchors/screws were exposed. This was located near the canopy.
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
Return Inspection

Compliance Date
12/7/2022
Violation
Furniture/equipment, rocking chair, in the I/T Unit 1 was not in good condition as evidenced by the seat was torn and had exposed foam.
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
Return Inspection

Compliance Date
12/7/2022
Violation
Furniture/equipment, orange shelf, in the school age area was not in good condition as evidenced by the top right corner was cracked and had exposed wood.
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
Return Inspection

Compliance Date

Violation
Furniture/equipment, 4 storage cubes, in the school age area was not in good condition as evidenced by the cubes were torn.
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
Return Inspection

Compliance Date
12/7/2022
Violation
Furniture/equipment, chair, in the pre-k room was not in good condition as evidenced by the seat was torn causing the chair to no longer be easily cleanable.
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
Return Inspection

Compliance Date

Violation
The facility did not meet requirements for cloth or plastic coated books. The facility needed an additional 12 items in this category.
Licensing Rule Reference
5 CSR 25-500.092 Furniture, Equipment and Materials (2) (C) 1. D. states: Cloth or plastic coated books.
Correction Required
The facility shall provide approved equipment as required.

Correction Verification
Return Inspection

Compliance Date
12/7/2022
5 CSR 25-500.102 Personnel
Violation
 Provider Comments
Violation
A facility orientation was not conducted for a caregiver(s) before being left alone with children. The following staff need a facility orientation: Hailey Bantle, Kaytlin Mifflin, Myah Paisley, Kendra Brewer and Jessica Schremp
Licensing Rule Reference
5 CSR 25-500.102 Personnel (1) (K) . states: The child care provider shall ensure that within seven (7) days of employment or volunteering and before being left alone with children that caregivers receive a facility orientation. The facility orientation shall include:
Correction Required
The facility shall ensure that a facility orientation occurs within 7 days of employment or volunteering and before caregivers are left alone with children.

Correction Verification
Return Inspection

Compliance Date
12/7/2022
Violation
A caregiver did not obtain one clock hour of training for each month of employment. The staff listed need the following information: Sara Whittaker needs 7 clock hours for 2021, Jocelynn Flentge needs 2 clock hours for 2021, Maecy Boxdorfer needs 2 clock hours for 2021, Danielle Agne needs 3 clock hours for 2021, Abbigale Schmidt needs 2 clock hours for 2021 and Debbie Talarski needs 1 clock hour for 2021. As of 5/25/2022, Sara Whittaker needs 7 clock hours, Maecy Boxdorfer needs 2 clock hours, Danielle Agne needs 3 clock hours, Abbigale Schmidt needs 2 clock hours and Debbie Talarski needs 1 clock hour for 2021. As of 8/8/2022, Sara Whittaker needs 7 clock hours, Maecy Boxdorfer needs 2 clock hours, Danielle Agne needs 3 clock hours and Debbie Talarski needs 1 clock hour for 2021. As of 12/7/2022, SW needs 7 clock hours, and MB needs 2 clock hours.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (3) (C) states: Caregivers who were employed after the first of the year shall obtain one (1) clock of hour training for each one (1) month of employment, regardless of the date employment began.
Correction Required
Required training hours shall be documented for each employee.

Correction Verification
Return Inspection

Compliance Date

Violation
The requirements for obtaining 12 clock hours each calendar year were not met. For the calendar year of 2021, the staff listed need the following information: Rachel Boatman needs 9 clock hours, Rachael Niermann needs 12 clock hours, Christina Paisley needs 7 clock hours, Katlynn Parker needs 8 clock hours, Marsha Parker needs 10 clock hours, Anna Schmidt needs 1 clock hour and Ann Wengert needs 5 clock hours. As of 5/25/2022, Rachel Boatman needs 9 hours, Christina Paisley needs 7 clock hours, Marsha Parker needs 10 clock hours and Anna Schmidt needs 1 clock hour.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (3) (A) states: The center director, group child care home provider, all other caregivers, and those volunteers who are counted in staff/child ratios shall obtain at least twelve (12) clock hours of child-care related training during each calendar year. Clock hour training shall be approved by the department.
Correction Required
Required training hours shall be documented for each caregiver.

Correction Verification
Return Inspection

Compliance Date

Violation
Safe sleep training was not completed within the past 3 years for the following staff Jocelynn Flentge, Maecy Boxdorfer, Danielle Agne, Abbigale Schmidt and Debbie Talarski. As of 5/25/2022, Abbigale Schmidt and Debbie Talarksi needs safe sleep training. As of 8/8/2022, Debbie Talarski, Rachael Niermann, Christina Paisley, Myah Paisley and Hailey Bantle needs safe sleep training. As of 12/7/2022, RN, CP, MP and HB need safe sleep training.
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

5 CSR 25-500.112 Staff/Child Ratios
Not Observed
5 CSR 25-500.122 Medical Examination Reports
Violation
 Provider Comments
Violation
Medical examination report(s) was/were not on file for Hailey Bantle and Myah Paisley as evidenced by a medical examination was not on file within 30 days of an individual beginning to work with children.
Licensing Rule Reference
5 CSR 25-500.122 Medical Examination Reports (1) (A) states: All persons working in a child care facility in any capacity during child care hours, including volunteers counted in staff/child ratios, shall be in good physical and emotional health with no physical or mental conditions which would interfere with child care responsibilities. These persons shall have a medical examination report, signed by a licensed physician or registered nurse who is under the supervision of a licensed physician, on file at the facility at the time of initial licensure or within thirty (30) days following employment.
Correction Required
Medical reports shall be on file as required.

Correction Verification
Return Inspection

Compliance Date
12/7/2022
Violation
A medical examination report did not include either a completed Risk Assessment for Tuberculosis form or a negative tuberculin skin test (TST) within 12 months of the individual's begin date at the facility for the following staff: Myah Paisley.
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
Return Inspection

Compliance Date

Violation
A medical examination report did not include either a completed Risk Assessment for Tuberculosis form or a negative tuberculin skin test (TST) within 12 months of the individual's begin date at the facility for the following staff: Jocelynn Flentge, Maecy Boxdorfer, Danielle Agne, Abbigale Schmidt and Debbie Talarski. As of 5/25/2022, Danielle Agne needs a Risk Assessment Form or skin test.
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
Return Inspection

Compliance Date
12/7/2022
5 CSR 25-500.132 Admission Policies and Procedures
Not Observed
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
Violation
 Provider Comments
Violation
Child(ren) was left without competent adult supervision as evidenced by on 8/5/2022, around 3:20 pm, Kendra Brewer was in a classroom with eight children. A few children were sitting/playing on the cots. The cots were stacked approximately 3 feet high and were located behind the desk. Kendra observed the children on the cots. Kendra was picking up shoes located near the cots, when a child climbed onto the cots. Kendra walked away from the cots. One child was helping another child off of the cots. In the process, the cots moved away from the wall, causing a two year old child to fall onto the ground. When this occurred, Kendra looked at the cot area. Kendra continued doing what she was doing. The two year old child approached Kendra. The child had blood on her face and clothes. Kendra picked the child up and ran out of the room. Seven children were left in the room unattended for 23 to 25 seconds. Video footage was observed. During the inspection on 12/7/2022 the Director stated that the employee was terminated 8/9/2022.
Licensing Rule Reference
5 CSR 25-500.182 Child Care Program (1) (A) 1. states: Caregivers shall not leave any child without competent adult supervision.
Correction Required
The facility shall provide competent adult supervision for each child as required.

Correction Verification
Submit Documentation

Compliance Date
12/7/2022
5 CSR 25-500.192 Health Care
Not Observed
5 CSR 25-500.202 Nutrition and Food Service
Not Observed
5 CSR 25-500.212 Transportation and Field Trips
Not Observed
5 CSR 25-500.222 Records and Reports
Not Observed
5 CSR 25-600.020 General Requirements
Violation
 Provider Comments
Violation
Criminal background check results were not on file for Kaytlin Mifflin, Myah Paisley, Kendra Brewer, Jessica Schremp and Mindy Tallevast.
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
Return Inspection

Compliance Date
12/7/2022
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