MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT

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Facility Information

Facility Name
THE GODDARD SCHOOL - LAKEWOOD

Facility DVN
002796701

Phone
(816) 293-9393

Physical Address
3301 NE RALPH POWELL RD
LEES SUMMIT
MO 64064-2368

Owner
TEN FIVE LLC

Mailing Address
309 NE DARTMORE CT
LEES SUMMIT
MO 64064-1601

Provider/Director
MICEK, MELISSA M

E-mail Address
LEESSUMMIT3MO@GODDARDSCHOOLS.COM

Incorporated

Child Care Specialist
ROBYN EMBREE

Age Range
6 WEEKS - 12 YEARS

Capacity
182

Facility Type
GROUP HOME AND CENTER

Limitations
24 CHILDREN IN THE INFANT/TODDLER UNIT; 12 CHILDREN UNDER 12 MONTHS

Inspection Information

Date
08/26/2024

Arrival Time
11:33 AM

Departure Time
12:42 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2476706403

Document	Document-Date
APPLICATION	07/14/2020
DIAGRAM/INDOOR	06/22/2020
DIAGRAM/OUTDOOR	06/22/2020
STAFF SHEET	07/20/2020
SAFE SLEEP POLICY	07/16/2020
LOCAL BUILDING APPROVAL	07/15/2020
LOCAL ZONING APPROVAL	07/15/2020
LOCAL FIRE DEPARTMENT NOTIFICATION	07/15/2020
DISASTER AND EMERGENCY PREPAREDNESS PLAN	07/20/2020
DISCIPLINE POLICIES	07/16/2020
DAILY SCHEDULE	06/28/2020
CHILD CARE PRACTICES	07/16/2020
SAMPLE WEEKLY MENU	05/26/2020
LLC OPERATING AGREEMENT	05/07/2020
JOB RESPONSIBILITIES	07/15/2020
LINES OF ADMINISTRATIVE AUTHORITY	07/15/2020
LLC ARTICLES OF ORGANIZATION	09/08/2019
POLICIES	07/16/2020
SAMPLE FORMS	07/17/2020
DIRECTOR'S QUALIFICATIONS	08/08/2020
FIRE/SAFETY INSPECTION	07/31/2024
ANNUAL DECLARATION	08/02/2024
SANITATION INSPECTION	06/04/2024
CERTIFICATE OF GOOD STANDING	08/14/2023
EQUIPMENT LIST	08/02/2024
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	08/26/2024

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 30

Total Children 133

Staff	Child	Class Age	Note
2	6	INFANTS AND TODDLERS	Sky Taylor ad Shannon Roberts (both staff) present with six children age 4-11 months.
2	8	INFANTS AND TODDLERS	Micah Allen and Isabell Sierna (both staff) present with eight children age 11-18 months
2	8	MIXED	Casi Lang and Amy Dehghani (both staff) present with eight children age 18-24 months
2	16	MIXED	Elizabeth Davidson and Jodie Chilton (both staff) present with sixteen children age 2-4 years with 1 child being 2 years old.
2	12	MIXED	Ashley Pointer and Alyssa Jensen (both staff) present with twelve children age 2-3 years with eight children being 2 years old.
8	0	NO CHILDREN IN ATTENDANCE	Jenni Kirley (cook), Hailey Whitten (staff), Hannah Gumminger (staff), Laura Neeley (admin), Brandi Backus (admin), Mitzi Micek (director), Abby Hendren (staff) and Yancy Backus (staff) all present with no children in attendance.
2	17	PRESCHOOL	Kathleen McCool and Jordan Martin (both staff) present with seventeen children age 3-4 years.
2	15	PRESCHOOL	Kayla Casey and Britney Casey (both staff) present with fifteen children age 3 years
2	15	PRESCHOOL	Jessica Sevens and Nazifa Shoaib (both staff) present with fifteen children age 4-5 years
3	20	PRESCHOOL	Tiffany Galvon, Stephanie Dolvin and Pam Barrett (all staff) present with twenty children age 4-5 years
2	9	TWO YEAR OLDS	Alana River and Shaelsa Francois (both staff) present with nine children age 2 years
1	7	TWO YEAR OLDS	Brooke Redburn (staff) present with seven children age 2 years

Compliance List
5 CSR 25-500.032 Organization and Administration Compliance
5 CSR 25-500.042 Licensing Process Compliance
5 CSR 25-500.052 Annual Requirements Compliance
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers Compliance
5 CSR 25-500.087 Fire Safety 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 Compliance
5 CSR 25-500.112 Staff/Child Ratios Compliance
5 CSR 25-500.122 Medical Examination Reports Compliance
5 CSR 25-500.132 Admission Policies and Procedures Compliance
5 CSR 25-500.142 Nighttime Care Compliance
5 CSR 25-500.162 Overlap Care of Children Not Observed
5 CSR 25-500.172 Emergency School Closings Not Observed
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 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