DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

CROCKER ACADEMY INC.

000467589

(573) 736-5922

324 S COMMERCIAL ST
CROCKER
MO  65452-9112

CROCKER ACADEMY INC.

PO BOX 222
CROCKER
MO  65452

ALLEN, KELI M

kelihelton@yahoo.com

Incorporated

ALLA GERASIMOVA

24 MONTHS - 12 YEARS

40

GROUP HOME AND CENTER

 
Inspection Information

09/16/2023

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2454746197


DocumentDocument-Date
DISCIPLINE POLICIES 08/14/2012
REGISTERING FICTITIOUS NAMES 06/14/2012
ARTICLES OF INCORPORATION 04/27/1992
LOCAL ZONING APPROVAL 08/14/1992
LINES OF ADMINISTRATIVE AUTHORITY 08/14/1992
JOB RESPONSIBILITIES 09/02/1992
SAMPLE FORMS 06/30/2008
CHILD CARE PRACTICES 08/14/1992
SAMPLE WEEKLY MENU 08/14/1992
DAILY SCHEDULE 08/14/1992
POLICIES 08/14/1992
DIAGRAM/OUTDOOR 08/14/1992
DIAGRAM/INDOOR 08/14/1992
DIRECTOR'S QUALIFICATIONS 09/19/2019
APPLICATION 08/13/2020
STAFF SHEET 07/28/2020
EQUIPMENT LIST 04/04/2023
SANITATION INSPECTION 06/26/2023
ANNUAL DECLARATION 04/04/2023
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 04/04/2023
FIRE/SAFETY INSPECTION 05/15/2023

Overlap Start TimeOverlap End TimeOverlap Submit Date
  3:00PM   5:00PM   6/8/2010



Inspection determined facility to be in compliance with licensing rules.
Compliance 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.

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
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
Violation
 Provider Comments
Violation
Outdoor equipment, an old slide structure with a blue tunnel, in the playground was unsafe as evidenced by it was not anchored to the ground.
Licensing Rule Reference
5 CSR 25-500.092 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 play equipment shall be safe and in good repair.

Correction Verification
Submit Documentation

Compliance Date
9/15/2023
Violation
Outdoor equipment, a police car, in the playground was not free of sharp parts as evidenced by one of the seats is missed, exposing a sharp metal base.
Licensing Rule Reference
5 CSR 25-500.092 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 play equipment shall be safe and in good repair.

Correction Verification
Submit Documentation

Compliance Date
9/15/2023
Violation
Outdoor equipment, a red airplane, in the playground was unsafe as evidenced by the back handle is loose, creating a hazard of falling.
Licensing Rule Reference
5 CSR 25-500.092 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 play equipment shall be safe and in good repair.

Correction Verification
Submit Documentation

Compliance Date
9/15/2023
Violation
Outdoor equipment, an old slide structure with a blue tunnel , in the playground was not free of pointed parts as evidenced by two rusted screws were sticking out of wooden horizontal surface.
Licensing Rule Reference
5 CSR 25-500.092 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 play equipment shall be safe and in good repair.

Correction Verification
Submit Documentation

Compliance Date
9/15/2023
5 CSR 25-500.102 Personnel
Violation
 Provider Comments
Violation
A facility orientation was not conducted for a caregiver(s) before being left alone with children. The following staff need a facility orientation: Kayla Busch
Licensing Rule Reference
5 CSR 25-500.102 Personnel (1) (K) . states: The child care provider shall ensure that within seven (7) days of employment or volunteering, and before being left alone with children, that caregivers employed on or after August 30, 2019, receive a facility orientation. The facility orientation shall include:
Correction Required
The facility shall ensure that a facility orientation occurs within 7 days of employment or volunteering and before caregivers are left alone with children.

Correction Verification
Submit Documentation

Compliance Date
9/15/2023
5 CSR 25-500.112 Staff/Child Ratios
Compliance
5 CSR 25-500.122 Medical Examination Reports
Violation
 Provider Comments
Violation
A medical examination report did not include either a Risk Assessment for Tuberculosis form or a negative tuberculin skin test (TST) for the following staff: Keli Allen .
Licensing Rule Reference
5 CSR 25-500.122 Medical Examination Reports (1) (B) . states: Medical examination reports shall include either a Tuberculosis (TB) Risk Assessment form, completed and signed by a health care professional, or a negative tuberculin skin test (TST) completed not more than twelve (12) months before beginning work in the facility. The Tuberculosis (TB) Risk Assessment form, revised March 2014, is incorporated by reference in this rule, as published by the Missouri Department of Health and Senior Services, PO Box 570, Jefferson City, MO 65102 and available by the Missouri Department of Health and Senior Services at https://health.mo.gov/living/healthcondiseases/communicable/tuberculosis/tbmanual/pdf/RiskAssessmentform.pdf. If the person has signs or symptoms of tuberculosis, or risk factors for tuberculosis, then testing for tuberculosis shall occur.
Correction Required
Medical examination reports shall include Risk Assessment for Tuberculosis forms or negative tuberculin skin test (TST) as required.

Correction Verification
Submit Documentation

Compliance Date
9/15/2023
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
Compliance
5 CSR 25-500.172 Emergency School Closings
Compliance
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
Compliance
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