MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
HERMITAGE R-IV SCHOOL DISTRICT

Facility DVN
002802033

Phone
(417) 745-6277

Physical Address
23824 POLK ST
HERMITAGE
MO 65668-8213

Owner
HERMITAGE R-IV SCHOOL DISTRICT

Mailing Address

Provider/Director
VENANCIO, DIANE CHRISTINE

E-mail Address
skobe@hermitage.k12.mo.us

Incorporated

Child Care Specialist
SHARLENE WHEATLEY

Age Range
5 YEARS - 15 YEARS

Capacity
32

Facility Type
SCHOOL AGE

Limitations
AFTER SCHOOL CARE ONLY

Inspection Information

Date
04/25/2023

Arrival Time
3:00 PM

Departure Time
3:45 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2446108678

Document	Document-Date
ANNUAL DECLARATION	10/26/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	10/26/2022
APPLICATION	06/24/2020
DAILY SCHEDULE	02/02/2020
CHILD CARE PRACTICES	06/23/2020
SAMPLE WEEKLY MENU	02/02/2020
STAFF SHEET	06/24/2020
DISCIPLINE POLICIES	06/24/2020
JOB RESPONSIBILITIES	02/02/2020
POLICIES	06/23/2020
LOCAL FIRE DEPARTMENT NOTIFICATION	06/29/2020
DISASTER AND EMERGENCY PREPAREDNESS PLAN	06/23/2020
DIRECTOR'S QUALIFICATIONS	01/22/2020
LINES OF ADMINISTRATIVE AUTHORITY	06/24/2020
DIRECTOR'S JOB RESPONSIBILITIES	06/24/2020
EQUIPMENT LIST	10/26/2022

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 2

Total Children 11

Staff	Child	Class Age	Note
1	6	SCHOOL AGE	Linda Rhine with six children ages 8 years to 12 years old.
1	5	SCHOOL AGE	Diane Vanancio with five children ages 5-7 years old.


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 25-500.090 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 25-500.172 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