DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

SOUTH CENTRAL MISSOURI COMMUNITY ACTION AGENCY

000687529

(573) 323-8905

1810 WINSTON DR
VAN BUREN
MO  63965

SOUTH CENTRAL MISSOURI COMMUNITY ACTION AGENCY

PO BOX 453
VAN BUREN
MO  63965

FORDHAM, BRENNA KAYLYNN

SCMCAA@HOTMAIL.COM

Incorporated

LESLEY WARREN

BIRTH - 3 YEARS

16

GROUP HOME AND CENTER

8 CHILDREN IN THE INFANT/TODDLER UNIT; 4 CHILDREN UNDER 12 MONTHS
 
Inspection Information

12/04/2024

1:55 PM

2:36 PM

UNANNOUNCED

COMPLIANCE MONITORING

2483510487


DocumentDocument-Date
DIAGRAM/INDOOR 06/12/2017
DIAGRAM/OUTDOOR 06/12/2017
DAILY SCHEDULE 07/12/2017
CHILD CARE PRACTICES 07/12/2017
LOCAL FIRE DEPARTMENT NOTIFICATION 06/28/2017
POLICIES 07/12/2017
LOCAL ZONING APPROVAL 06/28/2017
LOCAL BUILDING APPROVAL 06/22/2017
DISCIPLINE POLICIES 07/12/2017
JOB RESPONSIBILITIES 07/12/2017
LINES OF ADMINISTRATIVE AUTHORITY 07/12/2017
SAMPLE WEEKLY MENU 07/12/2017
DIRECTOR'S QUALIFICATIONS 02/11/2016
ARTICLES OF INCORPORATION 01/19/2011
SAFE SLEEP POLICY 07/12/2017
CERTIFICATE OF GOOD STANDING 04/03/2018
DISASTER AND EMERGENCY PREPAREDNESS PLAN 06/11/2020
APPLICATION 02/20/2020
SANITATION INSPECTION 03/28/2024
EQUIPMENT LIST 05/02/2024
FIRE/SAFETY INSPECTION 03/27/2024
ANNUAL DECLARATION 05/02/2024
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 05/02/2024




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.
Attendance at Time of Inspection
Total Staff 8
Total Children 15
StaffChildClass AgeNote
3 7 INFANTS AND TODDLERS Caregivers Kayla O'Connor, Kirsten Tod and Madison Hopkins 6 months through 18 months old
3 8 MIXED Caregivers Priscilla Zarate, Courtney Kosulandich and Hannah Goble 5- 2 year olds 3- 3 year olds
2 0 NO CHILDREN IN ATTENDANCE Director Brenna Fordham and Cook Angie Meade

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
Violation
 Provider Comments
Violation
The requirements for protective outlet covers or twist-lock outlets were not met as evidenced by electrical outlets were not covered in that a outlet cover was missing on the infant/toddler playground. The outlet was located just outside of the door to the playground.
Licensing Rule Reference
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (G) states: Protective outlet covers or twist-lock outlets shall be used in areas accessible to the children.
Correction Required
The facility shall use outlet covers or twist-lock outlets as required.

Correction Verification
Corrected on Site

Compliance Date
12/4/2024
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
Violation
 Provider Comments
Violation
Outdoor equipment, 3 pink tricycles, in the preschool playground was not in good condition as evidenced by the back of the seats were cracked and broken.
Licensing Rule Reference
5 CSR 25-500.092 Furniture, Equipment and Materials (3) (A) states: All outdoor equipment shall be constructed safely, in good condition and free of sharp, loose or pointed parts. Only lead-free paint shall be used.
Correction Required
Outdoor play equipment shall be safe and in good repair.

Correction Verification
Corrected on Site

Compliance Date
12/4/2024
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
Compliance
5 CSR 25-500.172 Emergency School Closings
Compliance
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