MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
KILLEEN, CARLEEN ANN

Facility DVN
000454020

Phone
(573) 885-2374

Physical Address
10 NORTHWOOD RD
CUBA
MO 65453-9700

Owner
KILLEEN, CARLEEN ANN

Mailing Address

Provider/Director
KILLEEN, CARLEEN ANN

E-mail Address
cakilleen@hotmail.com

Incorporated

Child Care Specialist
ALLA GERASIMOVA

Age Range
BIRTH - 12 YEARS

Capacity
10

Facility Type
FAMILY HOME

Limitations
UP TO 10 CHILDREN IN CARE NO MORE THAN 2 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 6 CHILDREN IN CARE NO MORE THAN 3 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER; IF ONLY 4 CHILDREN PRESENT, ALL CHILDREN MAY BE UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 10 CHILDREN IN CARE NO MORE THAN 4 CHILDREN UNDER AGE 2 WITH 2 ADULT CAREGIVERS

Inspection Information

Date
12/08/2022

Arrival Time
10:39 AM

Departure Time
12:25 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2436876836

Document	Document-Date
SAMPLE WEEKLY MENU	11/20/1991
SAMPLE FORMS	11/20/1991
POLICIES	11/20/1991
DIAGRAM/OUTDOOR	12/13/1991
DIAGRAM/INDOOR	11/20/1991
DAILY SCHEDULE	11/20/1991
CHILD CARE/DISCIPLINE POLICIES	11/20/1991
OWNER/PROVIDER REFERENCES	12/19/1991
ASSISTANT REFERENCES	12/23/1991
ASSISTANT APPROVAL REQUEST	09/07/2011
APPLICATION	10/01/2019
EQUIPMENT LIST	12/08/2022
FIRE/SAFETY INSPECTION	11/08/2022
SANITATION INSPECTION	09/20/2022
ANNUAL DECLARATION	12/08/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	12/15/2021

Overlap Start Time	Overlap End Time	Overlap Submit Date
3:30PM	5:00PM	8/15/2017
6:30AM	7:00AM	8/15/2017

Inspection determined facility to be in compliance with licensing rules.

Open Violations: 4

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 1

Total Children 3

Staff	Child	Class Age	Note
1	3	MIXED	CK is present with three children ages 11 month old, 12 month old and 3 years old.