DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

LICENSE EXEMPT PROGRAM INSPECTION REPORT
Facility Information

PEACE TABERNACLE DAYCARE

000570430

(636) 789-3668

11096 HIGHWAY 21
HILLSBORO
MO  63050

PEACE TABERNACLE, INC.



 

MITCHELL, AMANDA ELLEN

MITCHELL81504@GMAIL.COM

Incorporated

BRITTANY HECHT

24 MONTHS - 12 YEARS

49

LICENSE EXEMPT PROGRAM

 
Inspection Information

10/11/2023

9:32 AM

11:20 AM

ANNOUNCED

ANNUAL

2456568245


DocumentDocument-Date
FIRE/SAFETY INSPECTION 09/14/2023
SANITATION INSPECTION 06/29/2023
NOTICE OF PARENTAL RESPONSIBILITY 09/13/2023




Inspection determined facility to be in compliance with rules.
Compliance Licensing Rules
Open Violations: 6
Attendance at Time of Inspection
Total Staff 4
Total Children 12
StaffChildClass AgeNote
2 6 MIXED Jessica Rulo & Brenda Johnson, Caregivers 3 - 2 Year Olds 3 - 3 & 4 Year Olds
1 0 NO CHILDREN IN ATTENDANCE Amanda Mitchell, Director
1 6 PRESCHOOL Melissa Largent, Caregiver 6 - 4 Year Olds

Compliance List
5 CSR 25-300.020 Application for Annual Fire Safety and Health and Sanitation Inspections and Inspection Procedures
Violation
 Provider Comments
Violation
An approved Notice of Parental Responsibility was not on file for 2 child(ren).
Licensing Rule Reference
5 CSR 25-300.020 Application for Annual Fire Safety and Health and Sanitation Inspections and Inspection Procedures (6) (C) states: A child care facility operated by a religious organization shall provide the parent or guardian enrolling the child two (2) copies of the Notice of Parental Responsibility form for the enrolling parent to acknowledge, by signature, having read and accepted the information. One (1) copy shall be kept by the parent or guardian and the other copy shall be retained in the child's record at the facility.
Correction Required
The Notice of Parental Responsibility shall be provided to the parent or guardian upon enrollment, on file, and signed by the parent or guardian as required.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-300.040 Staffing Requirements
Compliance
5 CSR 25-300.050 Health Requirements
Violation
 Provider Comments
Violation
Medical examination reports including TB testing were not on file for caregivers as evidenced by the medical form did not contain all required information in that the Medical Provider failed to mark whether or not the patient was in good physical and emotional health and free of contagious disease for Mary Theissen.
Licensing Rule Reference
5 CSR 25-300.050 Health Requirements (1) (D) 2. states: The facility may use the department's physical assessment form, MO 580-1879 (6- 94), or the facility may use its own form if it contains all the information on the department's form.
Correction Required
Medical/TB reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-300.060 Responsibilities of Caregivers
Compliance
5 CSR 25-300.070 Fire Safety Requirements
Compliance
5 CSR 25-300.080 Sanitation Requirements
Violation
 Provider Comments
Violation
The facility was not clean, free of unsanitary conditions and free of pests as evidenced by mouse droppings were found in the upstairs Bathroom cabinet, under the sink.
Licensing Rule Reference
5 CSR 25-300.080 Sanitation Requirements (1) states: The premises of facilities shall be clean and free of unsanitary conditions and observable insects, spiders and rodents.
Correction Required
The facility shall be clean, sanitary and pest free.

Correction Verification
Corrected on Site

Compliance Date
10/11/2023
5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment
Violation
 Provider Comments
Violation
Hazardous items as follows were accessible to children: Clorox Wipes. The item(s) was/were located in the Preschool Room on the floor.
Licensing Rule Reference
5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment 1 (D) states: Hazardous materials such as cleaning supplies, poisonous materials, medicines, alcoholic beverages or hazardous personal care items shall be inaccessible to children and stored to prevent cross-contamination of food and food-related materials.
Correction Required
Hazardous material(s) shall be inaccessible to children and stored to prevent cross-contamination of food and food-related items.

Correction Verification
Corrected on Site

Compliance Date
10/11/2023
Violation
The walls located the Boys Bathroom, specifically the stall walls was/were not easily cleanable as evidenced by the walls were rusty towards the bottom.
Licensing Rule Reference
5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment 1 (F) states: Walls, ceilings, floors and equipment shall be finished with materials that can be cleaned easily and shall be free of splinters, cracks and chipped paint. Floor covering shall be in good condition. The facility shall be free of all lead hazards and asbestos that is friable or dangerous.
Correction Required
Walls, ceilings, and floors shall be made of approved materials, easily cleaned and in good condition.

Correction Verification
Submit Documentation

Compliance Date

Violation
The premises were not safe and suitable as evidenced by the TV in the Lunch/Nap Room was not secured to the wall or cart.
Licensing Rule Reference
5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment 1 states: The premises of all facilities shall be safe and suitable for the care of children.
Correction Required
The premises shall be safe and suitable for the care of children.

Correction Verification
Submit Documentation

Compliance Date

Violation
The premises were not safe and suitable as evidenced by the TV in the 2 Year Old Room was not secured to the wall or cabinet.
Licensing Rule Reference
5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment 1 states: The premises of all facilities shall be safe and suitable for the care of children.
Correction Required
The premises shall be safe and suitable for the care of children.

Correction Verification
Submit Documentation

Compliance Date

Violation
Hazardous items as follows were accessible to children: Shaving Cream. The item(s) was/were located in the lower cabinet in the Preschool Room.
Licensing Rule Reference
5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment 1 (D) states: Hazardous materials such as cleaning supplies, poisonous materials, medicines, alcoholic beverages or hazardous personal care items shall be inaccessible to children and stored to prevent cross-contamination of food and food-related materials.
Correction Required
Hazardous material(s) shall be inaccessible to children and stored to prevent cross-contamination of food and food-related items.

Correction Verification
Corrected on Site

Compliance Date
10/11/2023
Violation
Hazardous items as follows were accessible to children: Lotion, Clorox Wipes & Eye Glass Cleaner. The item(s) was/were located in the desk drawers in the Office (children pass through this area & have access to it).
Licensing Rule Reference
5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment 1 (D) states: Hazardous materials such as cleaning supplies, poisonous materials, medicines, alcoholic beverages or hazardous personal care items shall be inaccessible to children and stored to prevent cross-contamination of food and food-related materials.
Correction Required
Hazardous material(s) shall be inaccessible to children and stored to prevent cross-contamination of food and food-related items.

Correction Verification
Corrected on Site

Compliance Date
10/11/2023
Violation
The floors located in the Hallway was/were not in good condition as evidenced by the tiles in the threshold into the Office were missing.
Licensing Rule Reference
5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment 1 (F) states: Walls, ceilings, floors and equipment shall be finished with materials that can be cleaned easily and shall be free of splinters, cracks and chipped paint. Floor covering shall be in good condition. The facility shall be free of all lead hazards and asbestos that is friable or dangerous.
Correction Required
Walls, ceilings, and floors shall be made of approved materials, easily cleaned and in good condition.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-300.110 Admission Procedures and Required Reports and Records
Compliance
5 CSR 25-600.020 General Requirements
Compliance
5 CSR 25-600.040 Background Screening Findings
Compliance
RSMo 210.003 Immunizations of children required, when, exceptions--duties of administrator, report--notification of parents, when.
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.
Compliance
RSMo 210.254 Religious organization operating facilities exempt under licensing laws required to file parental notice of responsibility and fire, safety inspections annually.
Compliance
RSMo 210.255 Religious organizations operating facility in violation, procedure - noncompliance after notice, prosecutor may act or attorney general.
Compliance
RSMo 252. Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized.
Compliance