DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT
Facility Information

CLOUGH, KIMBERLY MARIE

003058257

(573) 619-9327

125 COUNTY ROAD 604
LINN
MO  65051-2736

CLOUGH, KIMBERLY MARIE



 

CLOUGH, KIMBERLY MARIE

cloughk6@yahoo.com


LAUREN R RAYWARNKE

6 WEEKS - 4 YEARS

10

FAMILY HOME

 
Inspection Information

01/14/2025

1:08 PM

2:35 PM

UNANNOUNCED

REINSPECTION

2485604949


DocumentDocument-Date
SAMPLE WEEKLY MENU 07/01/2024
CHILD CARE/DISCIPLINE POLICIES 06/26/2024
POLICIES 06/26/2024
SAFE SLEEP POLICY 04/30/2024
EQUIPMENT LIST 07/19/2024
SANITATION INSPECTION 06/25/2024
LICENSING ORIENTATION 06/15/2024
APPLICATION 03/19/2024
DAILY SCHEDULE 08/09/2024
LOCAL FIRE DEPARTMENT NOTIFICATION 08/01/2024
DISASTER AND EMERGENCY PREPAREDNESS PLAN 07/24/2024
DIAGRAM/OUTDOOR 04/17/2024
DIAGRAM/INDOOR 04/17/2024
FIRE/SAFETY INSPECTION 08/13/2024
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 08/13/2024
SAMPLE FORMS 08/13/2024




Inspection determined facility to be in compliance with licensing rules.
Compliance Licensing Rules
Open Violations: 4
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 3
Total Children 10
StaffChildClass AgeNote
1 10 MIXED At 1:08pm Caregiver Abigail Clough with 10 children, one child 4 months old, three children age 1, three children age 2, one child age 3, one child age 4 and one child age 5. At 1:44pm Provider Kim Clough and Caregiver Abigail Clough were present with 10 children, one child 4 months old, three children age 1, three children age 2, one child age 3, one child age 4 and one child age 5.
2 0 NO CHILDREN IN ATTENDANCE Additional Family Members Present: Alyssa Rickey (in a bedroom) and Evelyn Clough (in a downstairs living area) with 0 children.

Compliance List
5 CSR 25-400.025 Organization and Administration
Not Observed
5 CSR 25-400.045 Licensing Process
Violation
 Provider Comments
Violation
The ages of children was/were exceeded as evidenced by upon arrival at 1:08pm, Abigail Clough was present with 10 children, one child 4 months old, three children age 1, three children age 2, one child age 3, one child age 4 and one child age 5.
Licensing Rule Reference
5 CSR 25-400.045 Licensing Process (18) states: The number and ages of children a family child care home is authorized to have in care at any one time shall be specified on the license and shall not be exceeded except as permitted within these rules.
Correction Required
The provider shall maintain compliance with the specifications on the license.

Correction Verification
Corrected on Site

Compliance Date
1/14/2025
5 CSR 25-400.055 Annual Requirements
Not Observed
5 CSR 25-400.085 Physical Requirements of the Family Day Care Home
Violation
 Provider Comments
Violation
The use of potty chairs/junior commode/adaptor seat did not meet requirements as evidenced by the potty chair was not emptied.
Licensing Rule Reference
5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (2) (C) 2. states: Infants and toddlers. At least one (1) potty chair, junior commode or toilet with an adaptor seat shall be provided. Potty chairs shall be located in the bathroom and shall be emptied, cleaned and disinfected after each use.
Correction Required
The facility shall provide and clean/sanitize potty training equipment as required.

Correction Verification
Corrected on Site

Compliance Date
1/14/2025
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

5 CSR 25-400.090 Disaster and Emergency Preparedness
Violation
 Provider Comments
Violation
Requirements of facility's participation in disaster and emergency drills were not met as evidenced by the disaster or emergency drill was not held at least one time every three months.
Licensing Rule Reference
5 CSR 25-400.090 Disaster and Emergency Preparedness (3) (A) states: The licensee shall ensure that the facility has on file documentation that, at least every three (3) months, all staff and children at the facility have participated in a disaster or emergency drill based on the facility's disaster and emergency plan.
Correction Required
Fire, tornado, or other disaster drills shall be completed and recorded as required.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-400.095 Furniture, Equipment and Materials
Violation
 Provider Comments
Violation
Soft objects, loose bedding or any object that can increase risk of entrapment, suffocation or strangulation was observed as evidenced by a stuffed animal and blanket was observed in the a pack-n-play with an infant that was 4 months old.
Licensing Rule Reference
5 CSR 25-400.095 Furniture, Equipment and Materials (1) (B) 2 E states: Cribs, portable cribs and playpens shall be free of soft objects, loose bedding or any object that can increase the risk of entrapment, suffocation or strangulation. Examples include bumper pads, pillows, quilts, comforters, sleep positioning devices, sheepskins, blankets, flat sheets, cloth diapers, bibs, pillow-like toys, wedges, infant positioners, special mattresses, special sleep surfaces, and other similar items.
Correction Required
Infant napping equipment shall be free of soft objects, loose bedding or any object that can increase the risk of entrapment, suffocation or strangulation.

Correction Verification
Corrected on Site

Compliance Date
1/14/2025
5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel
Not Observed
5 CSR 25-400.115 Child Care Family and Household
Not Observed
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 11/4/2024.
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

5 CSR 25-400.135 Admission Policies and Procedures
Not Observed
5 CSR 25-400.145 Nighttime Care
Not Observed
5 CSR 25-400.155 Overlap Care of Children
Not Observed
5 CSR 25-400.165 Emergency School Closings
Not Observed
5 CSR 25-400.175 Child Care Program
Violation
 Provider Comments
Violation
Requirements for supervision of napping children were not met as evidenced by the door to the room in which children were napping was closed.
Licensing Rule Reference
5 CSR 25-400.175 Child Care Program (1) (A) 6 states: If children are napped with no caregiver in the room, the door to the room cannot be closed.
Correction Required
A caregiver shall supervise napping children.

Correction Verification
Corrected on Site

Compliance Date
1/14/2025
5 CSR 25-400.185 Health Care
Not Observed
5 CSR 25-400.190 Nutrition and Food Service
Not Observed
5 CSR 25-400.200 Transportation and Field Trips
Not Observed
5 CSR 25-400.210 Records and Reports
Violation
 Provider Comments
Violation
Daily attendance records were not maintained on file as required as evidenced by there were no child attendance records.
Licensing Rule Reference
5 CSR 25-400.210 Records and Reports (5) states: Daily child attendance records shall be maintained and kept on file a minimum of one (1) year.
Correction Required
Child attendance records shall be maintained and retained as required.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-600.020 General Requirements
Not Observed
5 CSR 25-600.040 Background Screening Findings
Not Observed
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.
Not Observed
RSMo 210.211.  License required - exceptions - written notice of licensure status, when.
Not Observed
RSMo 210.252. Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized.
Compliance