MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
BLOOMFIELD, ANNETTE PAMELA

Facility DVN
000786734

Phone
(573) 303-6220

Physical Address
1808 CUNNINGHAM RD
COLUMBIA
MO 65203-4725

Owner
BLOOMFIELD, ANNETTE PAMELA

Mailing Address

Provider/Director
BLOOMFIELD, ANNETTE PAMELA

E-mail Address
apbisme@gmail.com

Incorporated

Child Care Specialist
CYNTHIA D MADDOX

Age Range
12 MONTHS - 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; UP TO 8 CHILDREN IN CARE, ALL CHILDREN MAY BE UNDER AGE 2 WITH 2 ADULT CAREGIVERS

Inspection Information

Date
04/07/2023

Arrival Time
8:40 AM

Departure Time
9:25 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2444693891

Document	Document-Date
APPLICATION	07/22/2019
ASSISTANT APPROVAL REQUEST	10/21/2019
ASSISTANT REFERENCES	10/21/2019
CHILD CARE/DISCIPLINE POLICIES	10/21/2019
DAILY SCHEDULE	10/21/2019
DIAGRAM/INDOOR	08/27/2019
DIAGRAM/OUTDOOR	08/27/2019
DISASTER AND EMERGENCY PREPAREDNESS PLAN	10/21/2019
OWNER/PROVIDER REFERENCES	10/21/2019
POLICIES	10/21/2019
SAMPLE WEEKLY MENU	10/21/2019
EQUIPMENT LIST	10/27/2022
FIRE/SAFETY INSPECTION	10/20/2022
SANITATION INSPECTION	05/25/2022
ANNUAL DECLARATION	10/27/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	10/27/2022

Overlap Start Time	Overlap End Time	Overlap Submit Date
11:30AM	12:45PM	10/24/2019
3:30PM	4:15PM	10/24/2019

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 10

Staff	Child	Class Age	Note
1	10	MIXED	Annette Bloomfield was the provider with the children. Children ranged in age from 2 years to 5 1/2 years. Assistant Matt Bloomfield and 1 additional household member was in the house.


5 CSR 25-400.025 Organization and Administration Compliance
5 CSR 25-400.045 Licensing Process Compliance
5 CSR 25-400.055 Annual Requirements Not Observed
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 Not Observed
5 CSR 25-400.135 Admission Policies and Procedures Compliance
5 CSR 25-400.145 Nighttime Care Not Observed
5 CSR 25-400.155 Overlap Care of Children Not Observed
5 CSR 25-400.165 Emergency School Closings Not Observed
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 Not Observed
5 CSR 25-400.210 Records and Reports Not Observed
5 CSR 25-600.020 General Requirements Not Observed
5 CSR 25-600.040 Background Screening Findings Not Observed
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