MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT

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Facility Information

Facility Name
LICK CREEK ADVENTURES DAYCARE AND PRESCHOOL

Facility DVN
002595231

Phone
(573) 721-5523

Physical Address
105 W MAIN ST
PERRY
MO 63462-1105

Owner
STEVENER, KAYLA

Mailing Address
24311 SALT LICK PL
PERRY
MO 63462-2069

Provider/Director
STEVENER, KAYLA

E-mail Address
mossk03@hotmail.com

Incorporated

Child Care Specialist
BETHANY CARREL DUCKWORTH

Age Range
6 WEEKS - 12 YEARS

Capacity
20

Facility Type
GROUP HOME AND CENTER

Limitations
4 CHILDREN UNDER 24 MONTHS

Inspection Information

Date
01/19/2023

Arrival Time
9:50 AM

Departure Time
11:13 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2438849246

Document	Document-Date
APPLICATION	10/21/2019
DISASTER AND EMERGENCY PREPAREDNESS PLAN	12/04/2019
DAILY SCHEDULE	11/05/2019
DIAGRAM/INDOOR	12/04/2019
DIAGRAM/OUTDOOR	12/05/2019
DISCIPLINE POLICIES	11/05/2019
CHILD CARE PRACTICES	11/05/2019
POLICIES	11/05/2019
REGISTERING FICTITIOUS NAMES	10/28/2019
DIRECTOR'S QUALIFICATIONS	05/18/2016
SAMPLE WEEKLY MENU	11/05/2019
LINES OF ADMINISTRATIVE AUTHORITY	11/05/2019
JOB RESPONSIBILITIES	01/03/2020
SAFE SLEEP POLICY	12/11/2019
STAFF SHEET	01/03/2020
LOCAL ZONING APPROVAL	12/18/2019
SANITATION INSPECTION	09/13/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	12/26/2022
EQUIPMENT LIST	12/26/2022
FIRE/SAFETY INSPECTION	09/22/2022
ANNUAL DECLARATION	12/14/2022

Inspection determined facility to be in compliance with licensing rules.

Open Violations: 3

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 3

Total Children 16

Staff	Child	Class Age	Note
1	5	MIXED	Staff: Nicole Jarman. Age range 21 months through 2 years. Four 2 year old children.
2	11	MIXED	Staff: Kayla Stevener and Tricia Asquith. Age range 11 months through 5 years. One child under 12 months. Zero 2 year old children. 10 children ages 3-5 years.

Compliance List
5 CSR 25-500.032 Organization and Administration Compliance
5 CSR 25-500.042 Licensing Process Compliance
5 CSR 25-500.052 Annual Requirements Compliance
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 Violation
5 CSR 25-500.112 Staff/Child Ratios Compliance
5 CSR 25-500.122 Medical Examination Reports Compliance
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 Violation
5 CSR 25-600.020 General Requirements Violation
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