DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

DOUGLASS COMMUNITY SERVICES, INCORPORATED

000659630

(660) 263-7421

707 SINNOCK
MOBERLY
MO  65270

DOUGLASS COMMUNITY SERVICES, INCORPORATED

909 BROADWAY
HANNIBAL
MO  63401-4249

BOSS, SUSAN MARIE

moberlycm@douglassonline.org

Incorporated

AMY MITCHELL

36 MONTHS - 5 YEARS

60

GROUP HOME AND CENTER

 
Inspection Information

04/17/2025

10:00 AM

11:58 AM

UNANNOUNCED

COMPLIANCE MONITORING

2491362604


DocumentDocument-Date
LINES OF ADMINISTRATIVE AUTHORITY 10/06/2004
JOB RESPONSIBILITIES 10/06/2004
DIRECTOR'S QUALIFICATIONS 10/06/2004
ARTICLES OF INCORPORATION 10/06/2004
DAILY SCHEDULE 10/06/2004
DIAGRAM/OUTDOOR 10/06/2004
DIAGRAM/INDOOR 10/06/2004
LOCAL ZONING APPROVAL 10/06/2004
LOCAL BUILDING APPROVAL 10/06/2004
APPLICATION 04/24/2020
STAFF SHEET 07/01/2020
SAMPLE WEEKLY MENU 10/06/1994
DISASTER AND EMERGENCY PREPAREDNESS PLAN 04/13/2022
SAMPLE FORMS 04/13/2022
FIRE/SAFETY INSPECTION 12/04/2024
EQUIPMENT LIST 02/24/2025
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 02/25/2025
CERTIFICATE OF GOOD STANDING 02/22/2024
SANITATION INSPECTION 01/17/2025
POLICIES 04/26/2024
DISCIPLINE POLICIES 04/26/2024
CHILD CARE PRACTICES 04/26/2024
ANNUAL DECLARATION 02/24/2025




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 27
StaffChildClass AgeNote
2 13 MIXED Rhonda Piper and Kristine Rutherford where in attendance with thirteen children ages 3-years-old through 5-years-old.
3 14 MIXED Shameacke Bryant, Sativa Cotten and Velma Ferguson where in attendance with fourteen children ages 3-years-old through 5-years-old.
3 0 NO CHILDREN IN ATTENDANCE Susan Boss (director), Becky Kendrick (office staff), and Wanda Casen (volunteer) where present during inspection but did not count in child staff ratio.

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
Hazardous items as follows were accessible to children: hand lotion. The item(s) was/were located in the staff office between room A and B in a staff purse containing visible hand lotion was left within reach of children.
Licensing Rule Reference
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (I) states: All flammable liquids, matches, cleaning supplies, poisonous materials, medicines, alcoholic beverages, hazardous personal care items or other hazardous items shall be inaccessible to children.
Correction Required
Hazardous items shall be inaccessible to children.

Correction Verification
Corrected on Site

Compliance Date
4/17/2025
Violation
The walls located in room A was/were not in good condition as evidenced by chipping paint in between the R and A of the READ sign above two red rocking chairs. .
Licensing Rule Reference
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (2) (A) 6. states: Walls, ceilings and floors shall be finished with material which can be cleaned easily and shall be free of splinters, cracks and chipping paint. Floor covering shall be in good condition. Lead-free paint shall be used for all painted surfaces.
Correction Required
Walls, ceilings, and floors shall be made of approved materials, easily cleaned and in good condition.

Correction Verification
Corrected on Site

Compliance Date
4/17/2025
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
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: Rhonda Piper .
Licensing Rule Reference
5 CSR 25-500.122 Medical Examination Reports (1) (B) . 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 tuberculin skin test (TST) as required.

Correction Verification
Corrected on Site

Compliance Date
4/17/2025
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
Not Observed
5 CSR 25-500.212 Transportation and Field Trips
Not Observed
5 CSR 25-500.222 Records and Reports
Violation
 Provider Comments
Violation
1 child(ren) records did not include name, address and telephone number of another individual who might be reached in an emergency.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (C) states: Name, address and telephone number of another individual (friend or relative) who might be reached in an emergency when the parent(s), guardian or legal custodian cannot be reached;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Corrected on Site

Compliance Date
4/17/2025
5 CSR 25-600.020 General Requirements
Compliance
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