MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT

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Facility Information

Facility Name
THE GODDARD SCHOOL - LAKEWOOD

Facility DVN
002796701

Phone
(816) 293-9393

Physical Address
3301 NE RALPH POWELL RD
LEES SUMMIT
MO 64064-2368

Owner
TEN FIVE LLC

Mailing Address
309 NE DARTMORE CT
LEES SUMMIT
MO 64064-1601

Provider/Director
MICEK, MELISSA M

E-mail Address
LEESSUMMIT3MO@GODDARDSCHOOLS.COM

Incorporated

Child Care Specialist
ROBYN EMBREE

Age Range
6 WEEKS - 12 YEARS

Capacity
174

Facility Type
GROUP HOME AND CENTER

Limitations
32 CHILDREN IN THE INFANT/TODDLER UNIT; 12 CHILDREN UNDER 12 MONTHS

Inspection Information

Date
05/15/2023

Arrival Time
11:30 AM

Departure Time
12:35 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2447330292

Document	Document-Date
APPLICATION	07/14/2020
DIAGRAM/INDOOR	06/22/2020
DIAGRAM/OUTDOOR	06/22/2020
STAFF SHEET	07/20/2020
SAFE SLEEP POLICY	07/16/2020
LOCAL BUILDING APPROVAL	07/15/2020
LOCAL ZONING APPROVAL	07/15/2020
LOCAL FIRE DEPARTMENT NOTIFICATION	07/15/2020
DISASTER AND EMERGENCY PREPAREDNESS PLAN	07/20/2020
DISCIPLINE POLICIES	07/16/2020
DAILY SCHEDULE	06/28/2020
CHILD CARE PRACTICES	07/16/2020
SAMPLE WEEKLY MENU	05/26/2020
LLC OPERATING AGREEMENT	05/07/2020
JOB RESPONSIBILITIES	07/15/2020
LINES OF ADMINISTRATIVE AUTHORITY	07/15/2020
LLC ARTICLES OF ORGANIZATION	09/08/2019
POLICIES	07/16/2020
SAMPLE FORMS	07/17/2020
DIRECTOR'S QUALIFICATIONS	08/08/2020
FIRE/SAFETY INSPECTION	05/19/2022
ANNUAL DECLARATION	08/26/2022
SANITATION INSPECTION	05/02/2023
CERTIFICATE OF GOOD STANDING	07/07/2022
EQUIPMENT LIST	08/26/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	08/26/2022

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 28

Total Children 149

Staff	Child	Class Age	Note
2	6	INFANTS AND TODDLERS	Molly Wilton and Ashley Pointer (both staff) present with six children age 4-11 months.
2	8	INFANTS AND TODDLERS	Makayla Hicks and Alyssa Jensen (both staff) present with eight children age 10-15 months.
2	7	INFANTS AND TODDLERS	Micah Allen and Emma Moore (both staff) present with seven children age 13-20 months.
2	7	INFANTS AND TODDLERS	Kayla Casey and Isabelle Sirna (both staff) present with seven children age 18-23 months.
2	16	MIXED	Amanda Kirby and Hailey Whitten (both staff) present with sixteen children age 2-3 years.
6	0	NO CHILDREN IN ATTENDANCE	Melissa Micek (director), Pam Barrett (floater), Brandy Backis (assistant), Jenny Curley (check), Abby Hendren (staff) and Tessa Poterbin (floater) present with no children in attendance.
2	16	PRESCHOOL	Rebecca Davidson and Kathleen McCool (both staff) present with sixteen children age 3-4 years.
2	19	PRESCHOOL	Elizabeth Davidson and Mira Edwards (both staff) present with nineteen children age 3-4 years.
2	19	PRESCHOOL	Brooklyn Jones and Kelly Price (both staff) present with nineteen children age 4-5 years.
2	18	PRESCHOOL	Jessica Adams and Nazita Shoaib (both staff) present with eighteen children age 4-5 years.
2	18	PRESCHOOL	Bria Baggs and Tiffany Galvin (both staff) present with eighteen children age 4-5 years.
2	15	TWO YEAR OLDS	Amy Dehghani and Cathy Randalf (both staff) present with fifteen children age 2 years.


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 Not Observed
5 CSR 25-500.162 Overlap Care of Children Not Observed
5 CSR 25-500.172 Emergency School Closings Not Observed
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 Not Observed
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