MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
PAPER MOON NURSERY LLC

Facility DVN
002692706

Phone
(573) 289-2151

Physical Address
551 SOUTHAMPTON DR
COLUMBIA
MO 65203-3057

Owner
PAPER MOON NURSERY LLC

Mailing Address

Provider/Director
CARTER, ASHLYNN

E-mail Address
director@papermoonelc.com

Incorporated

Child Care Specialist
LU A GAINES

Age Range
BIRTH - 2 YEARS

Capacity
8

Facility Type
FAMILY HOME

Limitations
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

Date
08/01/2023

Arrival Time
12:13 PM

Departure Time
12:58 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2451628128

Document	Document-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.

Attendance at Time of Inspection

Total Staff 2

Total Children 6

Staff	Child	Class Age	Note
2	6	INFANTS AND TODDLERS	Ashlyn Carter and Emily Grace present with 6 children ages 9 weeks - 20 months.


5 CSR 25-400.025 Organization and Administration Compliance
5 CSR 25-400.045 Licensing Process Not Observed
5 CSR 25-400.055 Annual Requirements Not Observed
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 Compliance
5 CSR 25-400.115 Child Care Family and Household Compliance
5 CSR 25-400.125 Medical Examination Reports Not Observed
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 Compliance
5 CSR 25-400.185 Health Care Compliance
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. Compliance
RSMo 210.252. Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized. Compliance