MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
COOPER, CHRISTINE DAWN

Facility DVN

Phone
(660) 973-0789

Physical Address
1407 BURNAM RD
CHILLICOTHE
MO 64601

Owner
COOPER, CHRISTINE DAWN

Mailing Address

Provider/Director
COOPER, CHRISTINE DAWN

E-mail Address
chillicoffeeanyone@yahoo.com

Incorporated

Child Care Specialist
ELLEN DONOHO

Age Range
BIRTH - 12 YEARS

Capacity
10

Facility Type
FAMILY HOME

Limitations
IF ONLY 4 CHILDREN PRESENT, ALL CHILDREN MAY BE UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 10 CHILDREN IN CARE NO MORE THAN 2 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 10 CHILDREN IN CARE NO MORE THAN 4 CHILDREN UNDER AGE 2 WITH 2 ADULT CAREGIVERS; UP TO 6 CHILDREN IN CARE NO MORE THAN 3 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER

Inspection Information

Date
03/30/2023

Arrival Time
1:32 PM

Departure Time
2:00 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2444088236

Document	Document-Date
SAMPLE WEEKLY MENU	03/21/2011
SAMPLE FORMS	09/30/2012
OWNER/PROVIDER REFERENCES	09/07/2010
DIAGRAM/OUTDOOR	08/27/2012
DIAGRAM/INDOOR	08/27/2012
DAILY SCHEDULE	09/28/2012
POLICIES	09/28/2012
CHILD CARE/DISCIPLINE POLICIES	09/28/2012
ASSISTANT REFERENCES	04/24/2018
ASSISTANT APPROVAL REQUEST	04/24/2018
DISASTER AND EMERGENCY PREPAREDNESS PLAN	09/28/2012
SAFE SLEEP POLICY	12/11/2020
APPLICATION	06/11/2020
EQUIPMENT LIST	10/06/2022
SANITATION INSPECTION	06/06/2022
FIRE/SAFETY INSPECTION	10/07/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	10/06/2022
ANNUAL DECLARATION	05/17/2021

Overlap Start Time	Overlap End Time	Overlap Submit Date
11:15AM	11:45AM	1/23/2013
3:00PM	4:30PM	1/23/2013

Inspection determined facility to be in compliance with licensing rules.

Open Violations: NA

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 1

Total Children 8

Staff	Child	Class Age	Note
1	8	MIXED	1 year-4 years Crissy Cooper, staff