MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

INSPECTION REPORT

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Facility Information

Facility Name

Facility DVN

Phone

Physical Address

Owner

Mailing Address

Provider/Director

E-mail Address

Incorporated

Child Care Specialist

Age Range

Capacity

Facility Type

Limitations

Inspection Information

Date

Arrival Time

Departure Time

Notice

Inspection Type

Inspection ID

Document	Document-Date
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	04/26/2022
SAMPLE WEEKLY MENU	04/27/2011
REGISTERING FICTITIOUS NAMES	04/27/2011
SAMPLE FORMS	04/27/2011
POLICIES	04/27/2011
OWNER/PROVIDER REFERENCES	04/27/2011
LLC OPERATING AGREEMENT	04/27/2011
LLC ARTICLES OF ORGANIZATION	04/27/2011
LOCAL FIRE DEPARTMENT NOTIFICATION	04/27/2011
DIAGRAM/OUTDOOR	04/27/2011
DIAGRAM/INDOOR	04/27/2011
DAILY SCHEDULE	04/27/2011
CHILD CARE/DISCIPLINE POLICIES	04/27/2011
ASSISTANT REFERENCES	01/29/2013
ASSISTANT APPROVAL REQUEST	01/29/2013
APPLICATION	01/30/2019
CERTIFICATE OF GOOD STANDING	03/19/2019
DISASTER AND EMERGENCY PREPAREDNESS PLAN	07/25/2012
SAFE SLEEP POLICY	05/09/2019
FIRE/SAFETY INSPECTION	02/02/2023
EQUIPMENT LIST	04/26/2022
ANNUAL DECLARATION	04/26/2022
SANITATION INSPECTION	01/23/2023

Overlap Start Time	Overlap End Time	Overlap Submit Date
3:30PM	5:30PM	5/21/2013

Open Violations:

NOTE

The licensee is responsible for compliance with all licensing rules, including but not limited to the rules listed on this compliance report form.

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

Compliance

5 CSR 25-400.085 Physical Requirements of the Family Day Care Home

Compliance

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

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

Compliance

5 CSR 25-600.020 General Requirements

Violation

	Provider Comments
Violation Criminal background check results were not on file for LM. Licensing Rule Reference 5 CSR 25-600.020 General Requirements (1) states: Prior to the employment or presence of a child care staff member in a licensed, regulated, or registered child care facility not exempted by section 210.1080.13, RSMo, the child care provider shall request the results of a criminal background check for such child care staff member from the department. Correction Required Required results of criminal background checks shall be on file. Correction Verification Submit Documentation Compliance Date 2/15/2023

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