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 CRAYON ACADEMY, LLC

Facility DVN
002751900

Phone
(417) 362-9287

Physical Address
122 S JACKSON ST
MOUNTAIN VIEW
MO 65548-7410

Owner
THE CRAYON ACADEMY, LLC

Mailing Address
5518 S KIMBROUGH AVE
SPRINGFIELD
MO 65810-2730

Provider/Director
SOUTHWORTH, CAITLYN NICOLE

E-mail Address
HEATHERDEANN6@GMAIL.COM

Incorporated

Child Care Specialist
ELAINE S COX

Age Range
24 MONTHS - 12 YEARS

Capacity
40

Facility Type
GROUP HOME AND CENTER

Limitations

Inspection Information

Date
06/17/2023

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2448979708

Document	Document-Date
DIAGRAM/INDOOR	02/13/2019
DIAGRAM/OUTDOOR	02/13/2019
OWNER/PROVIDER REFERENCES	02/13/2019
LLC ARTICLES OF ORGANIZATION	01/15/2019
LOCAL FIRE DEPARTMENT NOTIFICATION	03/04/2019
JOB RESPONSIBILITIES	03/15/2019
SAMPLE WEEKLY MENU	03/15/2019
LOCAL ZONING APPROVAL	03/25/2019
ANNUAL DECLARATION	12/19/2022
EQUIPMENT LIST	12/19/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	12/22/2022
FIRE/SAFETY INSPECTION	11/16/2022
SANITATION INSPECTION	11/10/2022
DIRECTOR'S QUALIFICATIONS	05/19/2022
DISASTER AND EMERGENCY PREPAREDNESS PLAN	06/27/2022
LINES OF ADMINISTRATIVE AUTHORITY	06/27/2022
POLICIES	06/17/2022
CHILD CARE PRACTICES	06/27/2022
DISCIPLINE POLICIES	06/27/2022
DAILY SCHEDULE	06/17/2022
LLC OPERATING AGREEMENT	06/17/2022
LICENSING ORIENTATION	09/13/2018

Overlap Start Time	Overlap End Time	Overlap Submit Date
3:30PM	4:30PM	4/6/2020
7:30AM	8:30AM	4/6/2020

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.