DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT
Facility Information

PAPER MOON NURSERY LLC

002692706

(573) 289-2151

551 SOUTHAMPTON DR
COLUMBIA
MO  65203-3057

PAPER MOON NURSERY LLC



 

CARTER, ASHLYNN

director@papermoonelc.com


LU A GAINES

BIRTH - 2 YEARS

8

FAMILY HOME

8 CHILDREN UNDER 24 MONTHS; UP TO 8 CHILDREN IN CARE, ALL CHILDREN MAY BE UNDER AGE 2 WITH 2 ADULT CAREGIVERS; IF ONLY 4 CHILDREN PRESENT, ALL CHILDREN MAY BE UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 6 CHILDREN IN CARE NO MORE THAN 3 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 8 CHILDREN IN CARE NO MORE THAN 2 UNDER 2 W/ 1 CAREGIVER
 
Inspection Information

04/24/2023

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2445834821


DocumentDocument-Date
ASSISTANT APPROVAL REQUEST 03/06/2018
ARTICLES OF INCORPORATION 01/19/2018
CHILD CARE/DISCIPLINE POLICIES 03/06/2018
DISASTER AND EMERGENCY PREPAREDNESS PLAN 03/06/2018
DIAGRAM/INDOOR 03/06/2018
POLICIES 02/08/2018
DAILY SCHEDULE 02/08/2018
LLC OPERATING AGREEMENT 03/06/2018
SAFE SLEEP POLICY 02/08/2018
SAMPLE FORMS 02/08/2018
OWNER/PROVIDER REFERENCES 03/06/2018
SAMPLE WEEKLY MENU 02/08/2018
LLC ARTICLES OF ORGANIZATION 01/19/2018
APPLICATION 11/20/2019
SANITATION INSPECTION 01/09/2023
EQUIPMENT LIST 02/21/2023
FIRE/SAFETY INSPECTION 03/07/2023
ANNUAL DECLARATION 02/21/2023
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 02/21/2023
DIAGRAM/OUTDOOR 03/16/2018
LICENSING ORIENTATION 03/06/2018




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.

 
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
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
Violation
 Provider Comments
Violation
The requirements for obtaining 12 clock hours each calendar year were not met. For the calendar year of 2022, the staff listed need the following information: Olivia Meurer needs 12 hours.
Licensing Rule Reference
5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel (4) (A) states: The provider shall obtain at least twelve (12) clock hours of child care-related training during each calendar year. Any assistant who works or volunteers more than five (5) hours per week shall meet the same training requirements. Clock hour training shall be approved by the department.
Correction Required
Required training hours shall be documented for each caregiver.

Correction Verification
Submit Documentation

Compliance Date
4/24/2023
5 CSR 25-400.115 Child Care Family and Household
Compliance
5 CSR 25-400.125 Medical Examination Reports
Violation
 Provider Comments
Violation
A medical examination report did not include either a Risk Assessment for Tuberculosis form or a negative tuberculin skin test (TST) for the following staff: Ashley Mahieu is missing page 2 of the TB Risk assessment form that requires a Health Care Professionals' signature.
Licensing Rule Reference
5 CSR 25-400.125 Medical Examination Reports (1) (E) . states: Medical examination reports shall include either a Tuberculosis (TB) Risk Assessment form, completed and signed by a health care professional, or a negative tuberculin skin test (TST) completed not more than twelve (12) months before beginning work in the facility. The Tuberculosis (TB) Risk Assessment form, revised March 2014, is incorporated by reference in this rule, as published by the Missouri Department of Health and Senior Services, PO Box 570, Jefferson City, MO 65102 and available by the Missouri Department of Health and Senior Services at https://health.mo.gov/living/healthcondiseases/communicable/tuberculosis/tbmanual/pdf/RiskAssessmentform.pdf. If the person has signs or symptoms of tuberculosis, or risk factors for tuberculosis, then testing for tuberculosis shall occur.
Correction Required
Medical examination reports shall include Risk Assessment for Tuberculosis forms or negative tuberulin skin test (TST) as required.

Correction Verification
Submit Documentation

Compliance Date
3/14/2023
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