DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT
Facility Information

SHIPLEY, KELLY J

002069827

(660) 227-3402

619 W HARRISON ST
BUTLER
MO  64730-1303

SHIPLEY, KELLY J



 

SHIPLEY, KELLY J

KJSHIPLEY@HOTMAIL.COM


MARY C MALOID

BIRTH - 13 YEARS

10

FAMILY HOME

UP TO 10 CHILDREN IN CARE NO MORE THAN 2 CHILDREN 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; 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 4 CHILDREN UNDER AGE 2 WITH 2 ADULT CAREGIVERS
 
Inspection Information

06/01/2023

2:34 PM

2:34 PM

UNANNOUNCED

SUPPLEMENTAL

2448425013


DocumentDocument-Date
SAMPLE WEEKLY MENU 01/02/2008
POLICIES 01/27/2010
DIAGRAM/OUTDOOR 12/06/2007
DIAGRAM/INDOOR 12/06/2007
CHILD CARE/DISCIPLINE POLICIES 01/27/2010
DAILY SCHEDULE 12/06/2007
ASSISTANT APPROVAL REQUEST 12/14/2017
SAFE SLEEP POLICY 06/26/2018
DISASTER AND EMERGENCY PREPAREDNESS PLAN 10/01/2018
APPLICATION 10/30/2019
SANITATION INSPECTION 10/22/2021
FIRE/SAFETY INSPECTION 01/14/2022
EQUIPMENT LIST 09/15/2022
ANNUAL DECLARATION 09/15/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 09/15/2022

Overlap Start TimeOverlap End TimeOverlap Submit Date
  11:00AM   12:00PM   12/12/2019
  3:30PM   4:30PM   12/12/2019



Inspection determined facility to be in compliance with licensing rules.
Open Violations: 29
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
Not Observed
5 CSR 25-400.045 Licensing Process
Not Observed
5 CSR 25-400.055 Annual Requirements
Violation
 Provider Comments
Violation
The equipment list was not submitted.
Licensing Rule Reference
5 CSR 25-400.055 Annual Requirements (1) (B) states: A current list of available equipment.
Correction Required
The child care provider shall submit an equipment list as required.

Correction Verification
Submit Documentation

Compliance Date
2/8/2023
Violation
The listing of household members and assistants was not submitted.
Licensing Rule Reference
5 CSR 25-400.055 Annual Requirements (1) (C) states: A listing of household members and assistant(s).
Correction Required
The child care provider shall submit a listing of all household members and assistants.

Correction Verification
Submit Documentation

Compliance Date
2/14/2023
Violation
The Annual Declaration was not submitted.
Licensing Rule Reference
5 CSR 25-400.055 Annual Requirements (1) (A) states: An Annual Declaration for Licensed Facility form, revised 2021 and incorporated by reference in this rule. As published by the Missouri Department of Elementary and Secondary Education, PO Box 480, Jefferson City, MO 65102-0480 and available by the department at https://dese.mo.gov/childhood/forms, indicating the licensee’s intent to continue operating a licensed family child care home and agreement to comply with all statutes and department licensing rules;
Correction Required
The child care provider shall submit the Annual Declaration as required.

Correction Verification
Submit Documentation

Compliance Date
2/8/2023
Violation
The Family Care Safety Registry check was not conducted for Kelly Shipley within thirty (30) days prior to the anniversary date.
Licensing Rule Reference
5 CSR 25-400.055 Annual Requirements (2) (C) states: The child care provider shall conduct a Family Care Safety Registry check for all child care staff members within thirty (30) days prior to the anniversary date as printed on the license.
Correction Required
Required Family Care Safety Registry checks shall be conducted for all child care staff member(s) within thirty (30) days prior to the anniversary date.

Correction Verification
Submit Documentation

Compliance Date
2/7/2023
5 CSR 25-400.085 Physical Requirements of the Family Day Care Home
Violation
 Provider Comments
Violation
The walls located in the playroom was/were not in good condition as evidenced by chipped paint on wall and molding.
Licensing Rule Reference
5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (2) (A) 6. states: Walls, ceilings and floors shall be finished with material which can be cleaned easily and shall be free of splinters, cracks and chipping paint. Floor covering shall be in good condition. Lead-free paint shall be used for all painted surfaces.
Correction Required
Walls, ceilings, and floors shall be made of approved materials, easily cleaned and in good condition.

Correction Verification
Submit Documentation

Compliance Date
2/7/2023
5 CSR 25-400.086 Fire Safety
Violation
 Provider Comments
Violation
The requirements for protective outlet covers were not met as evidenced by 1 outlet did not have protective covers and a chipped outlet cover.
Licensing Rule Reference
5 CSR 25-400.086 Fire Safety 11 (B) states: Protective covers or inserts for electrical receptacles shall be installed in all areas occupied by children.
Correction Required
The facility shall use protective outlet covers as required.

Correction Verification
Submit Documentation

Compliance Date
2/7/2023
5 CSR 25-400.090 Disaster and Emergency Preparedness
Violation
 Provider Comments
Violation
The facility's written emergency plan did not include plans for medical and non-medical emergencies and disaster situations.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (A) 1. states: Medical and non-medical emergencies hazard to staff and children, such as a fire, tornado, flood, chemical spill, exposure to carbon monoxide, power failure, bomb threat, person coming to the facility whose health or behavior may be harmful to a child or staff member, or kidnapping.
Correction Required
Facility emergency plan must include required components.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's written emergency plan did not include plans for evacuation from the facility.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (A) 2. states: Evacuation from the facility in the event of a disaster emergency that could cause damage to the facility or pose a hazard to the staff and children.
Correction Required
Facility emergency plan must include required components.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's written emergency plan did not include plans for lock-down procedures.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (A) 3. states: Lock-down procedures in a situation that may result in harm to persons inside the facility such as a shooting, hostage incident, intruder, trespassing, or disturbance or to be used at the discretion of the director, designee, or public safety personnel.
Correction Required
Facility emergency plan must include required components.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's written emergency plan did not include plans for evacuation from a vehicle used to transport children.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (A) 4. states: Evacuation from a vehicle used to transport children.
Correction Required
Facility emergency plan must include required components.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility has not developed, implemented or maintained policies and procedures for responding to a disaster emergency.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (A) . states: The facility shall develop, implement, and maintain policies and procedures for responding to a disaster emergency, including a written plan for:
Correction Required
Facility must have plan on file as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's written plan does not consider the age or physical/mental abilities of children in care.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (B) 1. states: The age and physical and mental abilities of the children.
Correction Required
Facilities emergency plan should consider all contingencies.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's written plan does not consider the types of services currently offered to children in care.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (B) 2. states: The types of services offered, including whether the facility provides care for nonambulatory children or overnight care.
Correction Required
Facilities emergency plan should consider all contingencies.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's written plan does not consider the types of disasters or emergencies likely to affect the facility.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (B) 3. states: The types of disasters likely to affect the area.
Correction Required
Facilities emergency plan should consider all contingencies.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's written plan does not consider the requirements of the Division of Fire Safety and the DHSS's The ABC's of Emergency Preparedness Ready in 3 Program.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (B) 4. states: The requirements of the Division of Fire Safety and the Department of Health and Senior Services' The ABC's of Emergency Preparedness Ready in 3 Program (2006), which is incorporated by reference and is published by the Department of Health and Senior Services, Center for Emergency Response and Terrorism, PO Box 570, Jefferson City, MO 65102-0570, telephone number 573-526-4768, and is available at www.health.mo.gov, and advice from the Red Cross or other health and emergency professionals. This rule does not include any later amendments or additions.
Correction Required
Facilities emergency plan should consider all contingencies.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's written plan does not consider the need for ongoing communication with other agencies.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (B) 5. states: The need for ongoing communication and data sharing with other types of agencies providing services to children and with state and local emergency management agencies.
Correction Required
Facilities emergency plan should consider all contingencies.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's disaster plan did not include location of emergency information.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (C) 1. states: The location of the child's attendance record and emergency information and emergency supplies.
Correction Required
Facilities disaster plan shall include required components.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's disaster plan did not include exit routes to a safe location out of the facility.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (C) 2. states: Diagrams that identify exit routes from each area of the facility used for child care to a safe location out of the facility and to a safe location within the facility where children and staff members can stay until the threat of danger passes.
Correction Required
Facilities disaster plan shall include required components.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's disaster plan did not include exit routes to a safe location within the facility.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (C) 2. states: Diagrams that identify exit routes from each area of the facility used for child care to a safe location out of the facility and to a safe location within the facility where children and staff members can stay until the threat of danger passes.
Correction Required
Facilities disaster plan shall include required components.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's emergency procedure plan did not include use of alarms.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (C) 4. A. states: Use of alarms to warn other building occupants and summon staff;
Correction Required
Facilities emergency procedure must include required components.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's emergency procedure plan did not include an emergency call to the fire department.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (C) 4. B. states: Emergency telephone call to the fire department.
Correction Required
Facilities emergency procedure must include required components.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's emergency procedure plan did not include response to alarms.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (C) 4. C. states: Response to alarms.
Correction Required
Facilities emergency procedure must include required components.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's emergency procedure plan did not include isolation of a fire.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (C) 4. D. states: Isolation of a fire, including confinement by closing doors to the fire area.
Correction Required
Facilities emergency procedure must include required components.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's emergency procedure plan did not include evacuation of the immediate area.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (C) 4. E. states: Evacuation of the immediate area.
Correction Required
Facilities emergency procedure must include required components.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's emergency procedure plan did not include two off-site locations.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (C) 4. F. states: Two (2) off-site locations identified as meeting places in case of evacuation.
Correction Required
Facilities emergency procedure must include required components.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's emergency procedure plan did not include details for relocation.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (C) 4. G. states: Relocation as detailed in the disaster and emergency plan, including individuals with special needs, such as non-ambulatory children and children who sleep overnight, if applicable.
Correction Required
Facilities emergency procedure must include required components.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's emergency procedure plan did not include system of parental notification and re-unification.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (C) 4. H. states: System of contact for parents of children and notification of parents of the plan to assist in re-unification.
Correction Required
Facilities emergency procedure must include required components.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's disaster plan did not include disaster and emergency procedures to be followed.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (C) 4. . states: The disaster and emergency procedures to be followed, which include but are not limited to the following:
Correction Required
Facilities emergency procedure must include required components.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's lock-down procedures did not include announcement of lock-down by the director or designee.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (C) 5. A. states: An announcement of the lockdown by the director or designee. The alert may be made using a pre-selected code word.
Correction Required
Facilities emergency procedure must include required components.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's lock-down procedures did not include children kept in their classroom or other designated area.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (C) 5. B. states: In a lock-down situation, staff shall keep children in their rooms or other designated location that are away from the danger.
Correction Required
Facilities emergency procedure must include required components.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's disaster plan did not identify the staff responsible for implementing the plan and ensuring the safety of children.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (1) (C) . states: At a minimum, a disaster emergency plan shall identify the staff members responsible for implementing the plan and ensuring the safety of the children and shall include:
Correction Required
Facilities disaster plan shall include required components.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's disaster and emergency plan was not available in the office.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (2) (A) states: At all times, a copy of the facility's disaster emergency plan is readily available in the office area and in each room used for care of children.
Correction Required
The facilities disaster and emergency plan must be available in required locations.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's evacuation route diagram was not posted in each room used for child care.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (2) (B) 2. states: A diagram of evacuation routes from the room.
Correction Required
Facility must post information as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's special instructions for infants and non-ambulatory children were not posted in each room used for child care.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (2) (B) 3. states: Any special instructions for infants and non-ambulatory children.
Correction Required
Facility must post information as required.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-400.095 Furniture, Equipment and Materials
Violation
 Provider Comments
Violation
Outdoor equipment, tricycle, in playground was not in good condition as evidenced by hole in plastic seat.
Licensing Rule Reference
5 CSR 25-400.095 Furniture, Equipment and Materials 3 (A) states: All outdoor equipment shall be constructed safely, in good condition and free of sharp, loose or pointed parts. Only lead-free paint shall be used.
Correction Required
Outdoor equipment shall have no exposed hazards.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel
Not Observed
5 CSR 25-400.115 Child Care Family and Household
Not Observed
5 CSR 25-400.125 Medical Examination Reports
Violation
 Provider Comments
Violation
Requirements for infant-toddler/preschool child medical examination reports on file were not met as evidenced by there was no medical examination report on file within 30 days of admission - the admission date(s) was/were 8/23/20.
Licensing Rule Reference
5 CSR 25-400.125 Medical Examination Reports (2) (A) states: The provider shall require, within thirty (30) days following the admission of each infant, toddler or preschool child, a medical examination report signed by a licensed physician or registered nurse who is under the supervision of licensed physician and completed not more than twelve (12) months prior to admission. The provider may use the department’s medical assessment form or the provider may use its own form if it contains all the information on the department’s form. The Child Medical Examination Report (Infant/Toddler/Pre-School), revised 2021, is incorporated by reference in this rule, as published by the Missouri Department of Elementary and Secondary Education, PO Box 480, Jefferson City, MO 65102-0480 and available by the department at https://dese.mo.gov/childhood/forms. This rule does not incorporate any subsequent amendments or additions.
Correction Required
Child medical requirements shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
3/10/2023
5 CSR 25-400.135 Admission Policies and Procedures
Not Observed
5 CSR 25-400.145 Nighttime Care
Not Observed
5 CSR 25-400.155 Overlap Care of Children
Not Observed
5 CSR 25-400.165 Emergency School Closings
Not Observed
5 CSR 25-400.175 Child Care Program
Not Observed
5 CSR 25-400.185 Health Care
Not Observed
5 CSR 25-400.190 Nutrition and Food Service
Not Observed
5 CSR 25-400.200 Transportation and Field Trips
Not Observed
5 CSR 25-400.210 Records and Reports
Not Observed
5 CSR 25-600.020 General Requirements
Not Observed
5 CSR 25-600.040 Background Screening Findings
Not Observed
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.
Not Observed
RSMo 210.211.  License required - exceptions - written notice of licensure status, when.
Not Observed
RSMo 210.252. Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized.
Compliance