DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT
Facility Information

MICKELSON, KRISTINA LYNN

001838177

(573) 202-9925

11075 WOODALE DR
ROLLA
MO  65401

MICKELSON, KRISTINA LYNN



 

MICKELSON, KRISTINA LYNN

krissmickelson75@gmail.com


ALLA GERASIMOVA

BIRTH - 13 YEARS

10

FAMILY HOME

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

04/09/2023

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2444812927


DocumentDocument-Date
OWNER/PROVIDER REFERENCES 02/23/2004
SAMPLE WEEKLY MENU 05/05/2004
SAMPLE FORMS 02/02/2004
DAILY SCHEDULE 02/02/2004
CHILD CARE/DISCIPLINE POLICIES 02/02/2004
POLICIES 02/02/2004
DIAGRAM/OUTDOOR 07/30/2004
DIAGRAM/INDOOR 07/30/2004
ASSISTANT APPROVAL REQUEST 05/25/2010
APPLICATION 08/18/2020
FIRE/SAFETY INSPECTION 11/08/2022
SANITATION INSPECTION 09/14/2022
EQUIPMENT LIST 08/04/2022
ANNUAL DECLARATION 08/04/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 08/04/2022




Inspection determined facility to be in compliance with licensing rules.
Compliance 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.

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
Violation
 Provider Comments
Violation
The facility's outdoor space was not safe/well-maintained for children's activities as evidenced by all large plastic outside equipment is covered in mold, hazardous to the children. It was on large bridge/slide structure , two play houses, a small slide, a table and a slide located on the deck.
Licensing Rule Reference
5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (3) (A) 5. states: The play area shall be safe for children's activities, well-maintained, free of hazards such as poisonous plants, broken glass, rocks or other debris and shall have good drainage.
Correction Required
The outdoor play area shall be clean, safe and well-maintained as required.

Correction Verification
Submit Documentation

Compliance Date
4/9/2023
Violation
The facility's outdoor space was not safe/well-maintained for children's activities as evidenced by the top of the outdoor fence in two spots on the right side of the fence was disconnected from the horizontal bar . Broken pieces of a metal wire that used to connect the fence to the bar were hanging down on child's eye level presenting a hazard to the children. .
Licensing Rule Reference
5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (3) (A) 5. states: The play area shall be safe for children's activities, well-maintained, free of hazards such as poisonous plants, broken glass, rocks or other debris and shall have good drainage.
Correction Required
The outdoor play area shall be clean, safe and well-maintained as required.

Correction Verification
Submit Documentation

Compliance Date
4/6/2023
Violation
The facility's outdoor space was not safe/well-maintained for children's activities as evidenced by broken pieces of plastic, trash , including plastic bags, candy wrappers and large tree limbs that can be a potentially hazardous ( pocking, chocking hazards).
Licensing Rule Reference
5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (3) (A) 5. states: The play area shall be safe for children's activities, well-maintained, free of hazards such as poisonous plants, broken glass, rocks or other debris and shall have good drainage.
Correction Required
The outdoor play area shall be clean, safe and well-maintained as required.

Correction Verification
Submit Documentation

Compliance Date
4/6/2023
Violation
The bathroom was not clean and odor free as evidenced by the toilet bowl inside and outside was covered with black fecal residue around and under the ring, a splashes of human excrements were present on the plastic ring.
Licensing Rule Reference
5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (2) (C) 1. E. states: Bathrooms shall be clean and odor free.
Correction Required
Bathrooms shall be clean and odor free.

Correction Verification
Submit Documentation

Compliance Date
4/6/2023
Violation
Animal excrement was observed in an outdoor area used by children; the location of the excrement was in several spots on the playground, including a grass and pea gravel areas.
Licensing Rule Reference
5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (4) (D) states: Areas used by children shall be free of animal excrement.
Correction Required
No animal excrement shall be in areas used by children.

Correction Verification
Submit Documentation

Compliance Date
4/6/2023
Violation
Food and water dishes used by animals were accessible to children as evidenced by a bowl with a dog food and a water bowl were located at the kitchen .
Licensing Rule Reference
5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (4) (F) states: Food and water dishes used by animals shall not be accessible to the children.
Correction Required
Food and water dishes used by animals shall not be accessible to children.

Correction Verification
Submit Documentation

Compliance Date
4/9/2023
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
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
RSMo 210.252. Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized.
Compliance