DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT
Facility Information

PAPER MOON NURSERY LLC

002692706

(573) 441-0008

421 SANFORD AVE
COLUMBIA
MO  65203-3360

PAPER MOON NURSERY LLC



 

HAMMOND, EMILY LOU

director@papermoonelc.com


LU A GAINES

BIRTH - 2 YEARS

8

FAMILY HOME

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

10/02/2024

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2479414956


DocumentDocument-Date
APPLICATION 06/03/2024
FIRE/SAFETY INSPECTION 06/05/2024
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 07/02/2024
SANITATION INSPECTION 06/20/2024
DAILY SCHEDULE 06/20/2024
SAMPLE WEEKLY MENU 06/18/2024
SAMPLE FORMS 06/07/2024
CHILD CARE/DISCIPLINE POLICIES 06/18/2024
DISASTER AND EMERGENCY PREPAREDNESS PLAN 07/02/2024
LLC OPERATING AGREEMENT 06/20/2024
SAFE SLEEP POLICY 07/02/2024
POLICIES 06/18/2024
CERTIFICATE OF GOOD STANDING 06/18/2024
EQUIPMENT LIST 07/02/2024
DIAGRAM/OUTDOOR 06/21/2024
DIAGRAM/INDOOR 06/21/2024
LICENSING ORIENTATION 11/08/2017
LLC ARTICLES OF ORGANIZATION 06/18/2024




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
Violation
 Provider Comments
Violation
The family child care home is owned by a legal entity and did not designate a person to be responsible for the daily operation of the facility and to meet the requirements of the child care provider .
Licensing Rule Reference
5 CSR 25-400.025 Organization and Administration (2) states: If a family child care home is owned by a legal entity, the legal entity shall designate a person to be responsible for the daily operation of the facility and to meet the requirements of the child care provider. The department shall be notified in writing immediately if there is a change of the person designated to be responsible for the daily operation of the facility and to meet the requirements of the child care provider.
Correction Required
The legal entity shall designate a person responsible for the daily operation of the facility and notify the department immediately when there is a change.

Correction Verification
Submit Documentation

Compliance Date
9/10/2024
Violation
The family child care home is owned by a legal entity and did not immediately notify the department in writing of a change in the person designated to be responsible for the daily operation of the facility.
Licensing Rule Reference
5 CSR 25-400.025 Organization and Administration (2) states: If a family child care home is owned by a legal entity, the legal entity shall designate a person to be responsible for the daily operation of the facility and to meet the requirements of the child care provider. The department shall be notified in writing immediately if there is a change of the person designated to be responsible for the daily operation of the facility and to meet the requirements of the child care provider.
Correction Required
The legal entity shall designate a person responsible for the daily operation of the facility and notify the department immediately when there is a change.

Correction Verification
Submit Documentation

Compliance Date
9/10/2024
5 CSR 25-400.045 Licensing Process
Compliance
5 CSR 25-400.055 Annual Requirements
Compliance
5 CSR 25-400.085 Physical Requirements of the Family Day Care Home
Compliance
5 CSR 25-400.086 Fire Safety
Compliance
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
Violation
 Provider Comments
Violation
A facility orientation was not documented and available for review for all caregivers. The following staff need documentation of a facility orientation: Emily Hammond.
Licensing Rule Reference
5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel (1) (J) . states: The child care provider shall ensure that within seven (7) days of employment or volunteering and before being left alone with children, that caregivers employed on or after August 30, 2019, receive a facility orientation. The child care provider shall ensure that documentation verifying completion of the facility orientation is maintained and on file for review by the department for each caregiver. The facility orientation shall include:
Correction Required
The provider shall ensure that a facility orientation occurs within 7 days and documentation verifying completion is maintained and on file for review by the department for each caregiver.

Correction Verification
Submit Documentation

Compliance Date
9/17/2024
Violation
The provider did not conduct a Family Care Safety Registry screening for Emily Hammond, who was hired on 06/28/2024.
Licensing Rule Reference
5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel (1) (P) states: The child care provider shall conduct a Family Care Safety Registry screening prior to employment for any newly hired child care staff member who has a qualifying criminal background check result.
Correction Required
Required results of the Family Care Safety Registry screening shall be on file.

Correction Verification
Submit Documentation

Compliance Date
9/13/2024
5 CSR 25-400.115 Child Care Family and Household
Compliance
5 CSR 25-400.125 Medical Examination Reports
Violation
 Provider Comments
Violation
A medical examination report did not include either a Risk Assessment for Tuberculosis form or a negative tuberculin skin test (TST) for the following staff: Emily Hammond.
Licensing Rule Reference
5 CSR 25-400.125 Medical Examination Reports (1) (E) . states: Medical examination reports shall include either a Tuberculosis (TB) Risk Assessment form, completed and signed by a health care professional, or a negative tuberculin skin test (TST) completed not more than twelve (12) months before beginning work in the facility. The Tuberculosis (TB) Risk Assessment form, revised March 2014, is incorporated by reference in this rule, as published by the Missouri Department of Health and Senior Services, PO Box 570, Jefferson City, MO 65102 and available by the Missouri Department of Health and Senior Services at https://health.mo.gov/living/healthcondiseases/communicable/tuberculosis/tbmanual/pdf/RiskAssessmentform.pdf. If the person has signs or symptoms of tuberculosis, or risk factors for tuberculosis, then testing for tuberculosis shall occur.
Correction Required
Medical examination reports shall include Risk Assessment for Tuberculosis forms or negative tuberulin skin test (TST) as required.

Correction Verification
Submit Documentation

Compliance Date
9/11/2024
Violation
Medical examination report did not contain all required information as evidenced by Emily Hammond did not have a medical examination report on file at the facility.
Licensing Rule Reference
5 CSR 25-400.125 Medical Examination Reports (1) (G) states: The medical examination report form shall be supplied by the department or the provider may use his/her own form if it contains all the information on the department's form. The Medical Examination Report for Caregivers and Staff form, 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
Medical reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date
9/11/2024
5 CSR 25-400.135 Admission Policies and Procedures
Violation
 Provider Comments
Violation
An individualized plan for specialized care for a child with special physical, developmental or behavioral needs was not from a qualified professional source.
Licensing Rule Reference
5 CSR 25-400.135 Admission Policies and Procedures (4) states: A child who has a special physical, developmental or behavioral need shall have on file an individualized plan for specialized care from a professionally qualified source.
Correction Required
An individualized plan from a professional source shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date
10/2/2024
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 required immunizations verifying the type of vaccine and the month, day and year of administration was not on file for Child B child(ren).
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
10/2/2024
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
Violation
 Provider Comments
Violation
The provider failed to maintain accurate records to meet administrative requirements as evidenced by no Infant/Toddler Feeding and Care plan was on file for Child B.
Licensing Rule Reference
5 CSR 25-400.210 Records and Reports (1) states: The child care provider shall maintain accurate records to meet administrative requirements and to ensure knowledge of the individual needs of children and their families.
Correction Required
Accurate records shall be maintained.

Correction Verification
Submit Documentation

Compliance Date
9/30/2024
5 CSR 25-600.020 General Requirements
Violation
 Provider Comments
Violation
Criminal background check results were not on file for Emily Hammond.
Licensing Rule Reference
5 CSR 25-600.020 General Requirements (1) states: Prior to the employment or presence of a child care staff member in a licensed, regulated, or registered child care facility not exempted by section 210.1080.13, RSMo, the child care provider shall request the results of a criminal background check for such child care staff member from the department.
Correction Required
Required results of criminal background checks shall be on file.

Correction Verification
Submit Documentation

Compliance Date
9/11/2024
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