MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT

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Facility Information

Facility Name
WILLIAMS, TERRI D

Facility DVN
000911811

Phone
(660) 342-1133

Physical Address
672 W COMMERCIAL
KAHOKA
MO 63445

Owner
WILLIAMS, TERRI D

Mailing Address

Provider/Director
WILLIAMS, TERRI D

E-mail Address
terriwilliams933@gmail.com

Incorporated

Child Care Specialist
BETHANY CARREL DUCKWORTH

Age Range
BIRTH - 12 YEARS

Capacity
10

Facility Type
FAMILY HOME

Limitations
IF ONLY 4 CHILDREN PRESENT, ALL CHILDREN MAY BE UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 10 CHILDREN IN CARE NO MORE THAN 2 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 10 CHILDREN IN CARE NO MORE THAN 4 CHILDREN UNDER AGE 2 WITH 2 ADULT CAREGIVERS; UP TO 6 CHILDREN IN CARE NO MORE THAN 3 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER

Inspection Information

Date
11/29/2023

Arrival Time
10:00 AM

Departure Time
10:42 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2459702078

Document	Document-Date
ASSISTANT APPROVAL REQUEST	03/03/2017
DAILY SCHEDULE	09/17/2017
DISASTER AND EMERGENCY PREPAREDNESS PLAN	02/01/2012
SAFE SLEEP POLICY	01/14/2016
ASSISTANT REFERENCES	04/14/2017
CHILD CARE/DISCIPLINE POLICIES	09/19/2007
OWNER/PROVIDER REFERENCES	06/02/1997
DIAGRAM/INDOOR	09/20/2007
DIAGRAM/OUTDOOR	09/20/2007
SAMPLE WEEKLY MENU	02/20/1997
APPLICATION	07/31/2019
EQUIPMENT LIST	09/18/2023
SANITATION INSPECTION	08/08/2023
ANNUAL DECLARATION	09/18/2023
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	11/29/2023
FIRE/SAFETY INSPECTION	07/05/2023

Overlap Start Time	Overlap End Time	Overlap Submit Date
11:00AM	12:00PM	10/11/2018
2:45PM	3:45PM	10/11/2018

Inspection determined facility to be in compliance with 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.

Attendance at Time of Inspection

Total Staff 1

Total Children 7

Staff	Child	Class Age	Note
1	7	MIXED	Staff: Terri Williams. Age range 5 months through 2 years. Two children under 2 years old.