DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

THE GODDARD SCHOOL - LAKEWOOD

002796701

(816) 293-9393

3301 NE RALPH POWELL RD
LEES SUMMIT
MO  64064-2368

TEN FIVE LLC

309 NE DARTMORE CT
LEES SUMMIT
MO  64064-1601

MICEK, MELISSA M

LEESSUMMIT3MO@GODDARDSCHOOLS.COM


ROBYN EMBREE

6 WEEKS - 12 YEARS

182

GROUP HOME AND CENTER

24 CHILDREN IN THE INFANT/TODDLER UNIT; 12 CHILDREN UNDER 12 MONTHS
 
Inspection Information

08/14/2023

12:02 PM

1:46 PM

UNANNOUNCED

COMPLIANCE MONITORING

2452572259


DocumentDocument-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 08/14/2023
SANITATION INSPECTION 05/02/2023
CERTIFICATE OF GOOD STANDING 08/14/2023
EQUIPMENT LIST 08/14/2023
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 08/14/2023




Inspection determined facility to be in compliance with licensing rules.
Compliance Licensing Rules
Open Violations: 3
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 30
Total Children 140
StaffChildClass AgeNote
2 7 INFANTS AND TODDLERS Vicki Maciliffe and Alyssa Jensen (both staff) present with seven children age 3-10 months.
3 7 INFANTS AND TODDLERS Brea Baggs, Brittney Casey and Emma Moore (all staff) present with seven children age 1 year.
2 8 INFANTS AND TODDLERS Micah Allen and Makayla Hicks (both staff) present with eight children age 1 year.
2 15 MIXED Amanda Kirby and Tessa Potterman (both staff) present with fifteen children age 2-3 years with seven children being 2 years.
3 0 NO CHILDREN IN ATTENDANCE Yancy Backus, Mellany Accurso and Hailey Whitten (all staff) present with no children in attendance.
4 0 NO CHILDREN IN ATTENDANCE Brandi Backus (admin), Jenny Kelry (cook), Mitzi Micek (staff) and Abigail Hendren (staff) present with no children in attendance.
2 17 PRESCHOOL Shelby Adkin and Nora Townsend (both staff) present with seventeen children age 3-4 years.
2 14 PRESCHOOL Fiona Edwards and Ala Almusawi (both staff) present with fourteen children age 3-4 years.
2 14 PRESCHOOL Mahala Miller and Pam Mchenry-Barrett (both staff) present with fourteen children age 3-4 years.
2 17 PRESCHOOL Nazifa Snoaib and Kelly Price (both staff) present with seventeen children age 4-5 years.
2 20 PRESCHOOL Tiffany Galvin and Ione Johnson (both staff) present with twenty children age 4-5 years.
2 11 TWO YEAR OLDS Amy Dehghani and Kayla Casey (both staff) present with eleven children age 2 years.
2 10 TWO YEAR OLDS Hannah Gumminger and Katherine Randolph (bot staff) present with ten children age 2 years.

Compliance List
5 CSR 25-500.032 Organization and Administration
Compliance
5 CSR 25-500.042 Licensing Process
Compliance
5 CSR 25-500.052 Annual Requirements
Violation
 Provider Comments
Violation
The annual fire safety inspection was not conducted.
Licensing Rule Reference
5 CSR 25-500.052 Annual Requirements (2) (A) states: Evidence of compliance with a fire and safety inspection as conducted by the State Fire Marshal or his/her designee.
Correction Required
The facility shall submit evidence of compliance with annual fire safety requirements.

Correction Verification
Submit Documentation

Compliance Date

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
Violation
 Provider Comments
Violation
The requirements for obtaining 12 clock hours each calendar year were not met. For the calendar year of 2022, the staff listed need the following information: Katherine Randolph needs 2 training hours.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (3) (A) states: The center director, group child care home provider, all other caregivers, and those volunteers who are counted in staff/child ratios shall obtain at least twelve (12) clock hours of child-care related training during each calendar year. Clock hour training shall be approved by the department.
Correction Required
Required training hours shall be documented for each caregiver.

Correction Verification
Submit Documentation

Compliance Date

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
Compliance
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
Violation
 Provider Comments
Violation
Requirements for food sanitation were not maintained as evidenced by cots and bedding were out for nap while 1 child in classroom 5 and 12 children in classroom 6 were eating lunch.
Licensing Rule Reference
5 CSR 25-500.202 Nutrition and Food Service (1) (I) states: State or local rules, or both, governing food service sanitation shall be maintained in the storage, preparation and service of foods.
Correction Required
The facility shall follow state and local rules regarding food service sanitation.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-500.212 Transportation and Field Trips
Compliance
5 CSR 25-500.222 Records and Reports
Violation
 Provider Comments
Violation
1 child(ren) records did not include full name, home address, employers name and address, work schedule and home and work telephone numbers of the parent(s), guardian or legal custodian.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Corrected on Site

Compliance Date
8/14/2023
Violation
2 child(ren) records did not include name of family physician or hospital.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (D) states: Name and phone number of the family physician, hospital, or both, to be used in an emergency;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Corrected on Site

Compliance Date
8/14/2023
Violation
2 child(ren) records did not include telephone number of family physician or hospital.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (D) states: Name and phone number of the family physician, hospital, or both, to be used in an emergency;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Corrected on Site

Compliance Date
8/14/2023
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