MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT

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Facility Information

Facility Name
DOUGLASS COMMUNITY SERVICES, INCORPORATED

Facility DVN
002558647

Phone
(660) 395-1455

Physical Address
406 BLEES INDUSTRIAL DR
MACON
MO 63552-4451

Owner
DOUGLASS COMMUNITY SERVICES, INCORPORATED

Mailing Address
909 BROADWAY
HANNIBAL
MO 63401-4249

Provider/Director
KEUNE, KIMBERLY DENISE

E-mail Address
maconccpcm@douglassonline.org

Incorporated
Incorporated

Child Care Specialist
BETHANY CARREL DUCKWORTH

Age Range
6 WEEKS - 35 MONTHS

Capacity
16

Facility Type
GROUP HOME AND CENTER

Limitations

Inspection Information

Date
01/09/2025

Arrival Time
12:25 PM

Departure Time
1:15 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2485337145

Document	Document-Date
DIAGRAM/INDOOR	01/18/2016
SAMPLE WEEKLY MENU	01/08/2016
SAMPLE FORMS	01/08/2016
DISASTER AND EMERGENCY PREPAREDNESS PLAN	01/08/2016
ARTICLES OF INCORPORATION	09/15/2017
DAILY SCHEDULE	01/08/2016
DIAGRAM/OUTDOOR	07/11/2018
DIRECTOR'S QUALIFICATIONS	12/21/2018
JOB RESPONSIBILITIES	06/18/2018
SAFE SLEEP POLICY	05/06/2019
LINES OF ADMINISTRATIVE AUTHORITY	05/06/2019
LOCAL ZONING APPROVAL	10/28/2019
APPLICATION	10/15/2019
DISCIPLINE POLICIES	11/12/2019
POLICIES	11/12/2019
STAFF SHEET	10/28/2019
CHILD CARE PRACTICES	11/12/2019
SANITATION INSPECTION	10/29/2024
EQUIPMENT LIST	10/29/2024
CERTIFICATE OF GOOD STANDING	11/22/2021
ANNUAL DECLARATION	10/25/2024
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	10/25/2024
FIRE/SAFETY INSPECTION	09/11/2024

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 8

Total Children 13

Staff	Child	Class Age	Note
3	5	MIXED	Staff: Kimberly Walker, Morgan Nute and Alice Haddock. Age range 10 months through 2 years. One 2 year old child.
3	8	MIXED	Staff: Rachel Butner, Linda Newland, and Faith Whittle. Age range 18 months through 2 years. Five 2 year old children.
2	0	NO CHILDREN IN ATTENDANCE	Staff: Kim Kuene and Peggy Grant. Not counted in staff/child ratio at the time of inspection.

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 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