DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

LICENSE EXEMPT PROGRAM INSPECTION REPORT
Facility Information

ZION CHRISTIAN PRESCHOOL

002304161

(417) 319-4755

600 E ALDRICH RD
BOLIVAR
MO  65613-2573

ZION LUTHERAN CHURCH

PO BOX 5
BOLIVAR
MO  65613-0005

MANIS, LISA PARK

zcpbolivar@gmail.com


ELAINE S COX

24 MONTHS - 6 YEARS

26

LICENSE EXEMPT PROGRAM

 
Inspection Information

12/07/2023

10:10 AM

12:48 PM

ANNOUNCED

ANNUAL

2460216040


DocumentDocument-Date
FIRE/SAFETY INSPECTION 10/10/2023
NOTICE OF PARENTAL RESPONSIBILITY 08/02/2023
SANITATION INSPECTION 10/13/2023




Inspection determined facility to be in compliance with rules.
Compliance Licensing Rules
Open Violations: 3
Attendance at Time of Inspection
Total Staff 4
Total Children 18
StaffChildClass AgeNote
1 0 NO CHILDREN IN ATTENDANCE Lisa Manis not counting in staff/child ratio.
2 13 PRESCHOOL Jodee Bailey and Sonya Gorman, with 13 children ages 3-years-old to 5- years-old.
1 5 PRESCHOOL Hayley Hershenson with 5 children ages 3-years-old to 4-years-old.

Compliance List
5 CSR 25-300.020 Application for Annual Fire Safety and Health and Sanitation Inspections and Inspection Procedures
Compliance
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 Hayley Hershenson 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 25-300.050 Health Requirements (1) (D) . states: All caregivers working in a facility during child care hours shall be in good health. They shall have a physical assessment, including a tuberculosis status assessment by a licensed physician or registered professional nurse. A physical assessment report, signed by a licensed physician or registered professional nurse, shall be on file at the time of employment or within thirty (30) days following employment.
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
Compliance
5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment
Violation
 Provider Comments
Violation
The facility's outdoor space was not safe for children's activities as evidenced by the presence of black plastic ground cover exposed creating a tripping hazard in the fall zones of the swings and slide.
Licensing Rule Reference
5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment 4 (C) states: The play area shall be safe for children's activities. It shall be well-maintained and free of hazards such as poisonous plants, broken glass, barbed wire, open wells, rocks and other debris, and shall have good drainage.
Correction Required
The outdoor play area shall be clean, safe and well-maintained as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The equipment, a slide/swing set, that is over 24 inches high, does not have sufficient impact absorbing material present as evidenced by grass in the fall zone and a patch of bare ground at the base of the swings.
Licensing Rule Reference
5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment 4 (D) states: The fall-zone area under and around outdoor equipment over twenty-four inches (24") high covered with impact-absorbing materials that will effectively cushion the fall of a child. Materials may include sand, pea gravel, tanbark, shredded tires, wood chips, rubber matting or other approved resilient material.
Correction Required
Impact absorbent materials shall be in the fall zone for any equipment over 24 inches high.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-300.110 Admission Procedures and Required Reports and Records
Violation
 Provider Comments
Violation
The facility did not meet requirements for child enrollment and health information on file as evidenced by 2 child files did not have the full name of the parent(s), guardian or legal custodian, home address, employers’ name and address, work schedule and home and work telephone numbers.
Licensing Rule Reference
5 CSR 25-300.110 Admission Procedures and Required Reports and Records 2 (B) states: The full name of the parent(s), guardian or legal custodian, home address, work schedule, home and work telephone numbers, and employer's name and address.
Correction Required
An individual file with required information for each child shall be maintained.

Correction Verification
Corrected on Site

Compliance Date
12/7/2023
Violation
The facility did not meet requirements for child enrollment and health information on file as evidenced by 1 child files did not have the name, address and telephone number of another individual (friend or relative) who might be reached in an emergency.
Licensing Rule Reference
5 CSR 25-300.110 Admission Procedures and Required Reports and Records 2 (C) states: Full name, address and phone number of a friend or relative who might be reached in an emergency when a parent, guardian or legal custodian cannot be reached.
Correction Required
An individual file with required information for each child shall be maintained.

Correction Verification
Corrected on Site

Compliance Date
12/7/2023
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