MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

INSPECTION REPORT

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Facility Information

Facility Name

Facility DVN

Phone

Physical Address

Owner

Mailing Address

Provider/Director

E-mail Address

Incorporated

Child Care Specialist

Age Range

Capacity

Facility Type

Limitations

Inspection Information

Date

Arrival Time

Departure Time

Notice

Inspection Type

Inspection ID

Document	Document-Date
OWNER/PROVIDER REFERENCES	03/11/2003
ASSISTANT APPROVAL REQUEST	07/07/2010
SAMPLE FORMS	08/20/2004
SAMPLE WEEKLY MENU	08/20/2004
DAILY SCHEDULE	08/20/2004
CHILD CARE/DISCIPLINE POLICIES	09/10/2004
DIAGRAM/OUTDOOR	08/27/2004
DIAGRAM/INDOOR	08/27/2004
ASSISTANT REFERENCES	07/07/2010
POLICIES	09/10/2004
SAFE SLEEP POLICY	01/08/2018
DISASTER AND EMERGENCY PREPAREDNESS PLAN	01/24/2018
APPLICATION	08/07/2020
FIRE/SAFETY INSPECTION	05/31/2023
SANITATION INSPECTION	06/21/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	09/14/2023
ANNUAL DECLARATION	09/14/2023
EQUIPMENT LIST	09/14/2023

Overlap Start Time	Overlap End Time	Overlap Submit Date
4:00PM	6:00PM	8/28/2019

Open Violations:

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 25-400.025 Organization and Administration

Compliance

5 CSR 25-400.045 Licensing Process

Not Observed

5 CSR 25-400.055 Annual Requirements

Violation

	Provider Comments
Violation The annual sanitation inspection was not conducted. Licensing Rule Reference 5 CSR 25-400.055 Annual Requirements (2) (B) states: Evidence of compliance with local, state, or both, sanitation requirements. Correction Required The facility shall submit evidence of compliance with annual sanitation requirements. Correction Verification Submit Documentation Compliance Date

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

Compliance

5 CSR 25-400.135 Admission Policies and Procedures

Compliance

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

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

RSMo 210.252. Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized.

Compliance