DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

MISSION: ST. LOUIS

002727491

(314) 533-0975

1881 PINE ST
ST LOUIS
MO  63103-2264

MISSION: ST. LOUIS



 

MALONE, ERIN

erin.malone@missionstl.org

Incorporated

DENISE ELAYNE KOCH

5 YEARS - 15 YEARS

125

SCHOOL AGE

AFTER SCHOOL CARE ONLY
 
Inspection Information

09/25/2023

4:00 PM

5:51 PM

UNANNOUNCED

COMPLIANCE MONITORING

2456464929


DocumentDocument-Date
APPLICATION 07/31/2019
DIAGRAM/INDOOR 08/03/2019
DIAGRAM/OUTDOOR 08/03/2019
CHILD CARE PRACTICES 08/03/2019
DAILY SCHEDULE 08/03/2019
DIRECTOR'S QUALIFICATIONS 08/03/2019
DISASTER AND EMERGENCY PREPAREDNESS PLAN 08/03/2019
DISCIPLINE POLICIES 08/03/2019
JOB RESPONSIBILITIES 08/03/2019
LINES OF ADMINISTRATIVE AUTHORITY 08/03/2019
POLICIES 08/03/2019
SAMPLE FORMS 08/03/2019
SAMPLE WEEKLY MENU 08/03/2019
LOCAL FIRE DEPARTMENT NOTIFICATION 08/03/2019
ARTICLES OF INCORPORATION 08/03/2019
EQUIPMENT LIST 07/17/2023
STAFF SHEET 07/20/2022
ANNUAL DECLARATION 07/14/2023




Inspection determined facility to be in compliance with licensing rules.
Compliance Licensing Rules
Open Violations: 5
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 6
Total Children 52
StaffChildClass AgeNote
1 0 NO CHILDREN IN ATTENDANCE Rebekah Baumann, program manager, was present with no children.
1 10 SCHOOL AGE Eamon Lesco, teacher, was present with ten children, aged 11-years old to 13-years old.
1 13 SCHOOL AGE Ashlee Williams, teacher, was present with thirteen children, aged 7-years old to 8-years old.
1 11 SCHOOL AGE Christopher Teasely, teacher, was present with eleven children, aged 6-years old to 7-years old.
1 6 SCHOOL AGE Manuel Matus, teacher, was present with six children, aged 5-years old to 6-years old.
1 12 SCHOOL AGE Patrick Smith, site coordinator, was present with twelve children, aged 9-years old to 10-years old.

Compliance List
5 CSR 25-500.032 Organization and Administration
Compliance
5 CSR 25-500.042 Licensing Process
Violation
 Provider Comments
Violation
The name, address and telephone number of the board president was not prominently posted near the license.
Licensing Rule Reference
5 CSR 25-500.042 Licensing Process (13) (C) states: Board president or chairperson;
Correction Required
The name, address, and board president or chairperson shall be posted near the license.

Correction Verification
Submit Documentation

Compliance Date
4/10/2023
5 CSR 25-500.052 Annual Requirements
Violation
 Provider Comments
Violation
The staff sheet was not fully completed as evidenced by the information for Ben Holman, Board President, was not listed.
Licensing Rule Reference
5 CSR 25-500.052 Annual Requirements (1) (D) states: A current staff sheet.
Correction Required
The facility shall submit a current staff sheet as required.

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 25-500.090 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
Documentation of caregiver completion of the facility orientation was not on file for the following staff: Nahumi Tobar.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (1) (L) states: The child care provider shall ensure that documentation of caregiver completion of the facility orientation is maintained and on file for review by the department.
Correction Required
Documentation of caregiver completion of the facility orientation shall be maintained and on file for review by the department.

Correction Verification
Submit Documentation

Compliance Date

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 completed Risk Assessment for Tuberculosis form or a negative tuberculin skin test (TST) within 12 months of the individual's begin date at the facility for the following staff: Kayla Winter.
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 tuberulin skin test (TST) as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
Medical examination report was not on file for Kayla Winter as evidenced by a medical examination was not on file within 30 days of an individual beginning to work with children.
Licensing Rule Reference
5 CSR 25-500.122 Medical Examination Reports (1) (A) states: All persons working in a child care facility in any capacity during child care hours, including volunteers counted in staff/child ratios, shall be in good physical and emotional health with no physical or mental conditions which would interfere with child care responsibilities. These persons shall have a medical examination report, signed by a licensed physician or registered nurse who is under the supervision of a licensed physician, on file at the facility at the time of initial licensure or within thirty (30) days following employment.
Correction Required
Medical reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-500.132 Admission Policies and Procedures
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
Violation
 Provider Comments
Violation
Daily attendance records were not maintained on file as evidenced by there was no staff/volunteer attendance record for the following staff: Erin Malone.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (6) states: Daily staff and volunteer attendance records shall be maintained and kept on file a minimum of one (1) year.
Correction Required
Caregiver/volunteer attendance records shall be maintained/retained as required.

Correction Verification
Submit Documentation

Compliance Date

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