DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT
Facility Information

HALL, JACKIE MYRTLE

000496557

(417) 924-8338

2320 HIGHWAY 5
MANSFIELD
MO  65704-8303

HALL, JACKIE MYRTLE



 

HALL, JACKIE MYRTLE

jackiehall@centurytel.net


LACEY BERENDZEN

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 10 CHILDREN IN CARE NO MORE THAN 4 CHILDREN UNDER AGE 2 WITH 2 ADULT CAREGIVERS; 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
 
Inspection Information

12/27/2022

10:15 AM

12:31 PM

UNANNOUNCED

COMPLIANCE MONITORING

2438083571


DocumentDocument-Date
DAILY SCHEDULE 03/03/1997
ASSISTANT REFERENCES 08/27/2012
OWNER/PROVIDER REFERENCES 08/13/1996
SAMPLE WEEKLY MENU 08/27/1996
DIAGRAM/OUTDOOR 07/19/1996
DIAGRAM/INDOOR 07/19/1996
ASSISTANT APPROVAL REQUEST 08/27/1996
CHILD CARE/DISCIPLINE POLICIES 09/06/2002
POLICIES 09/06/2002
LOCAL FIRE DEPARTMENT NOTIFICATION 02/13/2018
SAFE SLEEP POLICY 02/13/2018
DISASTER AND EMERGENCY PREPAREDNESS PLAN 02/07/2018
FIRE/SAFETY INSPECTION 08/11/2022
EQUIPMENT LIST 10/28/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 10/28/2022
ANNUAL DECLARATION 10/28/2022
SANITATION INSPECTION 09/15/2022

Overlap Start TimeOverlap End TimeOverlap Submit Date
  3:40PM   3:55PM   7/30/2012
  7:00AM   7:45AM   7/30/2012



Inspection determined facility to be in compliance with licensing rules.
Compliance Licensing Rules
Open Violations: 7
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 2
Total Children 7
StaffChildClass AgeNote
2 7 MIXED JH and DR with 7 children. Two children age 1 year old, two children age 3 years old, two children age 4 years old, and one child age 5 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
A sex offender resides within 1000 feet of the family day care home and the facility's safety plan was not submitted.
Licensing Rule Reference
5 CSR 25-400.055 Annual Requirements (1) (D) states: A completed safety plan if a sex offender resides within 1,000 feet of the facility. If the provider has an existing safety plan, a new plan is not required.
Correction Required
The child care provider shall submit a safety plan as required for licensing.

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: open plastic diaper packaging. The item(s) was/were located underneath the open changing table shelves.
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
Submit Documentation

Compliance Date

5 CSR 25-400.086 Fire Safety
Compliance
5 CSR 25-400.090 Disaster and Emergency Preparedness
Violation
 Provider Comments
Violation
The facility's evacuation route diagram was not posted in each room used for child care.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (2) (B) 2. states: A diagram of evacuation routes from the room.
Correction Required
Facility must post information as required.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-400.095 Furniture, Equipment and Materials
Violation
 Provider Comments
Violation
The facility did not meet requirements for creative arts. The facility needed an additional 2 items in this category.
Licensing Rule Reference
5 CSR 25-400.095 Furniture, Equipment and Materials 2 (B) 2 C states: Creative arts
Correction Required
The facility shall provide appropriate equipment for children as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility did not meet requirements for music and rhythm activities. The facility needed an additional 2 items in this category.
Licensing Rule Reference
5 CSR 25-400.095 Furniture, Equipment and Materials 2 (B) 2 F states: Music and rhythm activities
Correction Required
The facility shall provide appropriate equipment for children as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
Requirements for the crib mattress/playpen pad/bedding were not met as evidenced by the mattress/pad was not sized correctly.
Licensing Rule Reference
5 CSR 25-400.095 Furniture, Equipment and Materials 1 (B) 2 C states: The crib mattress or playpen pad shall be sized correctly to the crib or playpen, in good condition, waterproof and kept clean and dry, be firm and maintain its shape even when the fitted sheet designated for that model is used, such that there are no gaps between the mattress and the side of the crib or playpen. Only fitted sheets shall be used and shall be changed immediately when soiled or wet.
Correction Required
Sleeping equipment shall meet safety and sanitation requirements.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel
Compliance
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
Violation
 Provider Comments
Violation
1 child(ren) records did not include field trip and transportation authorization.
Licensing Rule Reference
5 CSR 25-400.210 Records and Reports (2) (F) states: Field trip and transportation authorization.
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

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