MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT

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Facility Information

Facility Name
GOOD SHEPHERD NURSING HOME DISTRICT

Facility DVN
002609583

Phone
(573) 207-8874

Physical Address
610 HIGHWAY O
LAURIE
MO 65038

Owner
GOOD SHEPHERD NURSING HOME DISTRICT

Mailing Address
PO BOX 1068
LAURIE
MO 65038-1068

Provider/Director
FIKE, GARDITH ANN

E-mail Address
candrews@gsnhd1.com

Incorporated

Child Care Specialist
LACEY BERENDZEN

Age Range
24 MONTHS - 12 YEARS

Capacity
70

Facility Type
GROUP HOME AND CENTER

Limitations

Inspection Information

Date
01/19/2023

Arrival Time
9:30 AM

Departure Time
2:54 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2439544852

Document	Document-Date
DIAGRAM/OUTDOOR	07/14/2017
JOB RESPONSIBILITIES	10/23/2017
LINES OF ADMINISTRATIVE AUTHORITY	10/23/2017
DIAGRAM/INDOOR	10/23/2017
CHILD CARE PRACTICES	10/18/2017
POLICIES	10/23/2017
DISCIPLINE POLICIES	10/23/2017
LOCAL FIRE DEPARTMENT NOTIFICATION	12/12/2017
DIRECTOR'S QUALIFICATIONS	01/08/2011
DISASTER AND EMERGENCY PREPAREDNESS PLAN	11/09/2017
DAILY SCHEDULE	12/27/2017
SAMPLE WEEKLY MENU	10/23/2017
LOCAL BUILDING APPROVAL	01/11/2018
LOCAL ZONING APPROVAL	01/16/2018
APPLICATION	12/05/2019
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	01/04/2023
FIRE/SAFETY INSPECTION	08/30/2022
SANITATION INSPECTION	09/14/2022
EQUIPMENT LIST	01/04/2023
ANNUAL DECLARATION	01/04/2023

Inspection determined facility to be in compliance with licensing rules.

Open Violations: 11

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 6

Total Children 17

Staff	Child	Class Age	Note
1	0	NO CHILDREN IN ATTENDANCE	Hannah Smart - floating between classrooms as needed.
1	0	NO CHILDREN IN ATTENDANCE	Cynthia Andrews - in office with inspector and floating in classrooms.
1	0	NO CHILDREN IN ATTENDANCE	Sarah Butrum - joined preschool classroom around 12:00 pm.
1	9	PRESCHOOL	Allyssa Jones with 9 children, children age 3 and 4 years old.
2	8	TWO YEAR OLDS	Anne Miller and Serena Johnson with 8 children, children age 2 years old

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 Violation
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers Violation
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 Violation
5 CSR 25-500.132 Admission Policies and Procedures Violation
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