MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT

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Facility Information

Facility Name
GRACE LUTHERAN CHURCH, HOLTS SUMMIT MO

Facility DVN
002351753

Phone
(573) 896-8824

Physical Address
618 HALIFAX RD
HOLTS SUMMIT
MO 65043

Owner
GRACE LUTHERAN CHURCH, HOLTS SUMMIT MO

Mailing Address

Provider/Director
DIENER, MICHAEL J

E-mail Address
revmjdiener@gmail.com

Incorporated
Incorporated

Child Care Specialist
CYNTHIA D MADDOX

Age Range
24 MONTHS - 10 YEARS

Capacity
40

Facility Type
GROUP HOME AND CENTER

Limitations

Inspection Information

Date
03/20/2023

Arrival Time
8:40 AM

Departure Time
9:38 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2443401409

Document	Document-Date
DIRECTOR'S QUALIFICATIONS	09/12/2012
LINES OF ADMINISTRATIVE AUTHORITY	08/24/2012
JOB RESPONSIBILITIES	08/24/2012
CERTIFICATE OF GOOD STANDING	05/07/2011
ARTICLES OF INCORPORATION	08/24/2012
CHILD CARE PRACTICES	08/24/2012
DAILY SCHEDULE	08/24/2012
POLICIES	08/24/2012
DIAGRAM/OUTDOOR	07/15/2013
DIAGRAM/INDOOR	07/15/2013
SAMPLE WEEKLY MENU	01/13/2014
DISASTER AND EMERGENCY PREPAREDNESS PLAN	05/07/2011
DISCIPLINE POLICIES	05/07/2011
LOCAL BUILDING APPROVAL	05/07/2011
LOCAL FIRE DEPARTMENT NOTIFICATION	05/07/2011
LOCAL ZONING APPROVAL	05/07/2011
SAMPLE FORMS	05/07/2011
STAFF SHEET	08/05/2020
APPLICATION	08/05/2020
LICENSING ORIENTATION	08/24/2012
FIRE/SAFETY INSPECTION	10/26/2022
ANNUAL DECLARATION	09/14/2022
EQUIPMENT LIST	09/14/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	09/14/2022
SANITATION INSPECTION	07/07/2022

Inspection determined facility to be in compliance with licensing rules.

Open Violations: 1

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
3	16	MIXED	Michael Diener, Cindy Reed and Joy Krumm were the teachers with the children. Children ranged in age from 2 years to 5 years with 3 children being 2 years of age. April Krumm (volunteer) was also present at the facility.