DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT
Facility Information

KILLEEN, CARLEEN ANN

000454020

(573) 885-2374

10 NORTHWOOD RD
CUBA
MO  65453-9700

KILLEEN, CARLEEN ANN



 

KILLEEN, CARLEEN ANN

cakilleen@hotmail.com


ALLA GERASIMOVA

BIRTH - 12 YEARS

10

FAMILY HOME

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

12/08/2022

10:39 AM

12:25 PM

UNANNOUNCED

COMPLIANCE MONITORING

2436876836


DocumentDocument-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 TimeOverlap End TimeOverlap 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.
Compliance 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
StaffChildClass AgeNote
1 3 MIXED CK is present with three children ages 11 month old, 12 month old and 3 years old.

Compliance List
5 CSR 25-400.025 Organization and Administration
Compliance
5 CSR 25-400.045 Licensing Process
Compliance
5 CSR 25-400.055 Annual Requirements
Violation
 Provider Comments
Violation
The listing of household members and assistants was not submitted.
Licensing Rule Reference
5 CSR 25-400.055 Annual Requirements (1) (C) states: A listing of household members and assistant(s).
Correction Required
The child care provider shall submit a listing of all household members and assistants.

Correction Verification
Submit Documentation

Compliance Date

Violation
The Family Care Safety Registry check was not conducted for CK, KK, BH within thirty (30) days prior to the anniversary date.
Licensing Rule Reference
5 CSR 25-400.055 Annual Requirements (2) (C) states: The child care provider shall conduct a Family Care Safety Registry check for all child care staff members within thirty (30) days prior to the anniversary date as printed on the license.
Correction Required
Required Family Care Safety Registry checks shall be conducted for all child care staff member(s) within thirty (30) days prior to the anniversary date.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-400.085 Physical Requirements of the Family Day Care Home
Violation
 Provider Comments
Violation
Hazardous items as follows were accessible to children: ant/roach spray, Dawn soap and hand sanitizer . The item(s) was/were located on the floor near the bathroom entrance.
Licensing Rule Reference
5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (1) (J) states: All flammable liquids, matches, cleaning supplies, poisonous materials, medicines, alcoholic beverages, hazardous personal care items or other hazardous items shall be inaccessible to children.
Correction Required
Hazardous items shall be inaccessible to children.

Correction Verification
Corrected on Site

Compliance Date
12/8/2022
5 CSR 25-400.086 Fire Safety
Compliance
5 CSR 25-400.090 Disaster and Emergency Preparedness
Compliance
5 CSR 25-400.095 Furniture, Equipment and Materials
Compliance
5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel
Violation
 Provider Comments
Violation
The requirements for first aid and CPR certification were not met as evidenced by there was no documentation on file showing completion of age-appropriate CPR certification.
Licensing Rule Reference
5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel (1) (S) states: The provider shall have documentation on file at the home of current certification in age-appropriate first aid and cardiopulmonary resuscitation (CPR) training. The training shall be certified by a nationally-recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification, include an in-person skills assessment, and be approved by the department. At least one (1) caregiver with current certification in age-appropriate first aid and CPR must be on site at all times when children are present. First aid/CPR training may count toward the annual clock hour training requirement.
Correction Required
Required age-appropriate certification in first aid/CPR shall be on file, with at least one caregiver with certification on site.

Correction Verification
Submit Documentation

Compliance Date

Violation
The requirements for first aid and CPR certification were not met as evidenced by there was no documentation on file showing completion of age-appropriate first aid certification.
Licensing Rule Reference
5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel (1) (S) states: The provider shall have documentation on file at the home of current certification in age-appropriate first aid and cardiopulmonary resuscitation (CPR) training. The training shall be certified by a nationally-recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification, include an in-person skills assessment, and be approved by the department. At least one (1) caregiver with current certification in age-appropriate first aid and CPR must be on site at all times when children are present. First aid/CPR training may count toward the annual clock hour training requirement.
Correction Required
Required age-appropriate certification in first aid/CPR shall be on file, with at least one caregiver with certification on site.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-400.115 Child Care Family and Household
Compliance
5 CSR 25-400.125 Medical Examination Reports
Compliance
5 CSR 25-400.135 Admission Policies and Procedures
Compliance
5 CSR 25-400.145 Nighttime Care
Compliance
5 CSR 25-400.155 Overlap Care of Children
Compliance
5 CSR 25-400.165 Emergency School Closings
Compliance
5 CSR 25-400.175 Child Care Program
Compliance
5 CSR 25-400.185 Health Care
Compliance
5 CSR 25-400.190 Nutrition and Food Service
Compliance
5 CSR 25-400.200 Transportation and Field Trips
Compliance
5 CSR 25-400.210 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
RSMo 210.252. Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized.
Compliance