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
APPLICATION	07/20/2021
DIAGRAM/INDOOR	07/20/2021
DIAGRAM/OUTDOOR	07/20/2021
LOCAL BUILDING APPROVAL	07/20/2021
LOCAL FIRE DEPARTMENT NOTIFICATION	07/20/2021
LINES OF ADMINISTRATIVE AUTHORITY	07/20/2021
JOB RESPONSIBILITIES	07/20/2021
DIRECTOR'S QUALIFICATIONS	07/20/2021
DISASTER AND EMERGENCY PREPAREDNESS PLAN	07/20/2021
DAILY SCHEDULE	07/20/2021
SAMPLE WEEKLY MENU	07/20/2021
CHILD CARE PRACTICES	07/20/2021
DISCIPLINE POLICIES	07/20/2021
LLC ARTICLES OF ORGANIZATION	07/20/2021
POLICIES	07/20/2021
SAFE SLEEP POLICY	07/20/2021
LLC OPERATING AGREEMENT	08/02/2021
ANNUAL DECLARATION	07/18/2022
FIRE/SAFETY INSPECTION	06/13/2022
SANITATION INSPECTION	05/11/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	08/30/2022
CERTIFICATE OF GOOD STANDING	08/30/2022
EQUIPMENT LIST	08/30/2022

Overlap Start Time	Overlap End Time	Overlap Submit Date
3:00PM	5:00PM	8/12/2021

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 25-500.032 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

Violation

	Provider Comments
Violation The requirements for protective outlet covers or twist-lock outlets were not met as evidenced by electrical outlets were not covered in that one socket in the toddler room did not have a safety cover in the plug. Licensing Rule Reference 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (G) states: Protective outlet covers or twist-lock outlets shall be used in areas accessible to the children. Correction Required The facility shall use outlet covers or twist-lock outlets as required. Correction Verification Corrected on Site Compliance Date 2/22/2023

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

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

Not Observed

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