DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

FOUR LEAF CLOVER PRESCHOOL

002168729

(573) 632-6400

3525 COUNTRY CLUB DR
JEFFERSON CITY
MO  65109

DANDELION PRESCHOOL LLC



 

WILLIAMS, MARCELLA JO

fourleafmarcella@gmail.com


LAUREN R RAYWARNKE

6 WEEKS - 12 YEARS

120

GROUP HOME AND CENTER

8 CHILDREN UNDER 12 MONTHS; 16 CHILDREN UNDER 24 MONTHS
 
Inspection Information

12/28/2022

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2438046467


DocumentDocument-Date
LINES OF ADMINISTRATIVE AUTHORITY 09/06/2012
JOB RESPONSIBILITIES 09/20/2012
DIRECTOR'S QUALIFICATIONS 09/20/2012
SAMPLE FORMS 09/06/2012
CHILD CARE PRACTICES 09/06/2012
SAMPLE WEEKLY MENU 09/06/2012
DAILY SCHEDULE 09/06/2012
POLICIES 09/06/2012
DIAGRAM/OUTDOOR 09/06/2012
DIAGRAM/INDOOR 09/06/2012
STAFF SHEET 07/22/2020
APPLICATION 07/27/2020
EQUIPMENT LIST 08/10/2022
FIRE/SAFETY INSPECTION 11/08/2022
ANNUAL DECLARATION 08/10/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 08/10/2022
SANITATION INSPECTION 06/14/2022




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.

 
5 CSR 25-500.032 Organization and Administration
Compliance
5 CSR 25-500.042 Licensing Process
Compliance
5 CSR 25-500.052 Annual Requirements
Violation
 Provider Comments
Violation
The annual fire safety inspection was not approved.
Licensing Rule Reference
5 CSR 25-500.052 Annual Requirements (2) (A) states: Evidence of compliance with a fire and safety inspection as conducted by the State Fire Marshal or his/her designee.
Correction Required
The facility shall submit evidence of compliance with annual fire safety requirements.

Correction Verification
Submit Documentation

Compliance Date
11/8/2022
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers
Compliance
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
Violation
 Provider Comments
Violation
A medical examination report included either a Risk Assessment for Tuberculosis form or a negative tuberculin skin test (TST) which was completed more than 12 months before beginning work in the facility for the following staff: caregiver T.R..
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
Submit Documentation

Compliance Date
12/28/2022
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