MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT

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Facility Information

Facility Name
DOUGLASS COMMUNITY SERVICES, INCORPORATED

Facility DVN
001584898

Phone
(573) 406-5574

Physical Address
2161 JOHNSON ST
HANNIBAL
MO 63401-5843

Owner
DOUGLASS COMMUNITY SERVICES, INCORPORATED

Mailing Address
909 BROADWAY
HANNIBAL
MO 63401-4249

Provider/Director
BROKES-MARTIN, TAMMY

E-mail Address
EHSCM@DOUGLASSONLINE.ORG

Incorporated
Incorporated

Child Care Specialist
BETHANY CARREL DUCKWORTH

Age Range
6 WEEKS - 35 MONTHS

Capacity
24

Facility Type
GROUP HOME AND CENTER

Limitations

Inspection Information

Date
04/12/2023

Arrival Time
11:30 AM

Departure Time
12:07 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2445089892

Document	Document-Date
APPLICATION	02/22/2019
STAFF SHEET	04/04/2019
DIAGRAM/INDOOR	05/06/2010
DIAGRAM/OUTDOOR	05/06/2010
SAFE SLEEP POLICY	01/07/2016
DISCIPLINE POLICIES	02/26/2010
CHILD CARE PRACTICES	02/26/2010
POLICIES	02/26/2010
ARTICLES OF INCORPORATION	05/24/1993
JOB RESPONSIBILITIES	08/10/2006
LINES OF ADMINISTRATIVE AUTHORITY	08/17/2004
DAILY SCHEDULE	09/05/2002
SAMPLE WEEKLY MENU	09/10/2002
LOCAL BUILDING APPROVAL	09/05/2008
DISASTER AND EMERGENCY PREPAREDNESS PLAN	03/02/2021
DIRECTOR'S QUALIFICATIONS	09/18/2020
CERTIFICATE OF GOOD STANDING	02/26/2021
LOCAL ZONING APPROVAL	02/26/2021
FIRE/SAFETY INSPECTION	01/18/2023
EQUIPMENT LIST	04/12/2023
SANITATION INSPECTION	12/06/2022
ANNUAL DECLARATION	02/15/2023
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	02/15/2023

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 5

Total Children 6

Staff	Child	Class Age	Note
4	6	MIXED	Staff: Lori Grimes, Jeremy Shuck, Jane Kidd, and Laura Keesey. Age range 12 months through 2 years. Three 2 year old children.
1	0	NO CHILDREN IN ATTENDANCE	Staff: Tammy Brokes-Martin. Director. Not counted in child/staff ratio.


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 Compliance
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 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