DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT
Facility Information

JANSEN, KIM D

002016400

(573) 619-4279

71 COTE DESSEIN LN
BONNOTS MILL
MO  65016-2338

JANSEN, KIM D



 

JANSEN, KIM D

kimjansen128@gmail.com


LAUREN R RAYWARNKE

BIRTH - 12 YEARS

10

FAMILY HOME

UP TO 10 CHILDREN IN CARE NO MORE THAN 2 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 6 CHILDREN IN CARE NO MORE THAN 3 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER; 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 4 CHILDREN UNDER AGE 2 WITH 2 ADULT CAREGIVERS; UP TO 8 CHILDREN IN CARE, ALL CHILDREN MAY BE UNDER AGE 2 WITH 2 ADULT CAREGIVERS
 
Inspection Information

02/06/2024

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2463783174


DocumentDocument-Date
SAMPLE WEEKLY MENU 01/02/2007
ASSISTANT REFERENCES 05/12/2010
POLICIES 01/02/2007
DAILY SCHEDULE 01/02/2007
CHILD CARE/DISCIPLINE POLICIES 01/02/2007
DIAGRAM/OUTDOOR 01/02/2007
DIAGRAM/INDOOR 01/02/2007
APPLICATION 08/16/2018
ASSISTANT APPROVAL REQUEST 11/20/2019
SAFETY PLAN 12/01/2020
SANITATION INSPECTION 02/02/2024
FIRE/SAFETY INSPECTION 09/27/2023
EQUIPMENT LIST 01/10/2024
ANNUAL DECLARATION 01/10/2024
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 01/10/2024

Overlap Start TimeOverlap End TimeOverlap Submit Date
  3:45PM   5:30PM   9/14/2010
  7:00AM   7:15AM   9/14/2010



Inspection determined facility to be in compliance with licensing rules.
Compliance 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.

Compliance List
5 CSR 25-400.025 Organization and Administration
Compliance
5 CSR 25-400.045 Licensing Process
Compliance
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
2/6/2024
5 CSR 25-400.085 Physical Requirements of the Family Day Care Home
Compliance
5 CSR 25-400.086 Fire Safety
Violation
 Provider Comments
Violation
Requirements of 19 CSR 30-61.086 Fire Safety were not met as evidenced by fire drills were not held at least one time each month.
Licensing Rule Reference
5 CSR 25-400.086 Fire Safety (2) (C) states: Child care staff shall conduct at least one (1) fire drill each month and a disaster drill at least every three (3) months. The disaster drills shall include tornado drills. The provider shall maintain a written record at the facility of the date, type of drill, time required to evacuate the building, and number of children present during the drill.
Correction Required
Fire, tornado, and other disaster drills shall be completed and recorded as required.

Correction Verification
Submit Documentation

Compliance Date
1/19/2024
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
Violation
 Provider Comments
Violation
Requirements for infant-toddler/preschool child medical examination reports on file were not met as evidenced by there was no medical examination report on file within 30 days of admission - the admission date(s) was/were 7-19-2023.
Licensing Rule Reference
5 CSR 25-400.125 Medical Examination Reports (2) (A) states: The provider shall require, within thirty (30) days following the admission of each infant, toddler or preschool child, a medical examination report signed by a licensed physician or registered nurse who is under the supervision of licensed physician and completed not more than twelve (12) months prior to admission. The provider may use the department’s medical assessment form or the provider may use its own form if it contains all the information on the department’s form. The Child Medical Examination Report (Infant/Toddler/Pre-School), revised 2021, is incorporated by reference in this rule, as published by the Missouri Department of Elementary and Secondary Education, PO Box 480, Jefferson City, MO 65102-0480 and available by the department at https://dese.mo.gov/childhood/forms. This rule does not incorporate any subsequent amendments or additions.
Correction Required
Child medical requirements shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
1/18/2024
5 CSR 25-400.135 Admission Policies and Procedures
Compliance
5 CSR 25-400.145 Nighttime Care
Compliance
5 CSR 25-400.155 Overlap Care of Children
Compliance
5 CSR 25-400.165 Emergency School Closings
Compliance
5 CSR 25-400.175 Child Care Program
Compliance
5 CSR 25-400.185 Health Care
Violation
 Provider Comments
Violation
Requirements for immunization reports on file were not met as evidenced by 1 child's immunization record(s) was/were not on file .
Licensing Rule Reference
5 CSR 25-400.185 Health Care (4) (A) states: No child shall be permitted to enroll in or attend any day care facility caring for ten (10) or more children unless the child has been adequately immunized against vaccine preventable childhood illnesses specified by the department in accordance with recommendations of Immunization Practices Advisory Committee (ACIP). The parent or guardian of the child shall provide satisfactory evidence of the required immunizations. Satisfactory evidence means a statement, certificate or record from a physician or other recognized health facility or personnel, stating that the required immunizations have been given to the child and verifying the type of vaccine and the month, day and year of administration.
Correction Required
Child immunization requirements shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
1/19/2024
5 CSR 25-400.190 Nutrition and Food Service
Compliance
5 CSR 25-400.200 Transportation and Field Trips
Compliance
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