DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

LICENSE EXEMPT PROGRAM INSPECTION REPORT
Facility Information

TRINITY DAYCARE

002117346

(660) 258-7020

224 S MAIN
BROOKFIELD
MO  64628

TRINITY UNITED METHODIST CHURCH OF BROOKFIELD, MISSOURI



 

CLEMENTS, ALEXIS ROXANNE

alexisrclements@gmail.com

Incorporated

ELLEN DONOHO

BIRTH - 12 YEARS

80

LICENSE EXEMPT PROGRAM

10 CHILDREN UNDER 24 MONTHS
 
Inspection Information

06/04/2025

9:00 AM

10:45 AM

ANNOUNCED

ANNUAL

2494547783


DocumentDocument-Date
NOTICE OF PARENTAL RESPONSIBILITY 10/21/2024
FIRE/SAFETY INSPECTION 05/26/2025
SANITATION INSPECTION 05/12/2025




Inspection determined facility to be in compliance with rules.
Compliance Licensing Rules
Open Violations: 7
Attendance at Time of Inspection
Total Staff 7
Total Children 32
StaffChildClass AgeNote
2 5 INFANTS AND TODDLERS 8 months-1 year. Tara Packman and Maggie Foster, providers
3 16 MIXED 2-4 year old children 4- two year old children Brittany Pickens, Jenna Jurkofsky and Heather Billips, providers
2 11 SCHOOL AGE 5 years-11 years Tara Vanosdoll and Ashlyn Calvert, provider

Compliance List
5 CSR 25-300.020 Application for Annual Fire Safety and Health and Sanitation Inspections and Inspection Procedures
Compliance
5 CSR 25-300.040 Staffing Requirements
Violation
 Provider Comments
Violation
A caregiver has not reviewed the rules of this chapter as evidenced by None of the caregivers had the statement of understanding in the file..
Licensing Rule Reference
5 CSR 25-300.040 Staffing Requirements (2) states: All caregivers shall review the rules of this chapter.
Correction Required
All caregivers shall review the rules as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility did not meet requirements for requests/results of a check of the Family Care Safety Registry. A background check on file is older than two years for the following staff member(s): Rachel Skinner did not have the Family Care Safety Registry in the file.
Licensing Rule Reference
5 CSR 25-300.040 Staffing Requirements (7) states: A check of the Family Care Safety Registry shall be conducted for all child care staff members of nursery schools every two (2) years.
Correction Required
Required requests/results of background checks shall be on file.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-300.050 Health Requirements
Violation
 Provider Comments
Violation
Medical examination reports including TB testing were not on file for caregivers as evidenced by the medical form did not contain all required information in that Heather Billups form does not include the statement of good hearlth.
Licensing Rule Reference
5 CSR 25-300.050 Health Requirements (1) (D) 2. states: The facility may use the department's physical assessment form, MO 580-1879 (6- 94), or the facility may use its own form if it contains all the information on the department's form.
Correction Required
Medical/TB reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
Medical examination reports, including TB testing, were not on file for Jenna Jurofsky, Kayla Henry and Tara Packman as evidenced by a medical examination was not on file within 30 days of an individual beginning to work with children.
Licensing Rule Reference
5 CSR 25-300.050 Health Requirements (1) (D) . states: All caregivers working in a facility during child care hours shall be in good health. They shall have a physical assessment, including a tuberculosis status assessment by a licensed physician or registered professional nurse. A physical assessment report, signed by a licensed physician or registered professional nurse, shall be on file at the time of employment or within thirty (30) days following employment.
Correction Required
Medical/TB reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
Requirements for immunization reports on file were not met as evidenced by verification of required immunizations was not satisfactory in that the exemption was not correct.
Licensing Rule Reference
5 CSR 25-300.050 Health Requirements (3) states: Child care facilities shall meet immunization requirements for children as defined by section 210.003, RSMo.
Correction Required
Child immunization requirements shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-300.060 Responsibilities of Caregivers
Compliance
5 CSR 25-300.070 Fire Safety Requirements
Compliance
5 CSR 25-300.080 Sanitation Requirements
Compliance
5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment
Violation
 Provider Comments
Violation
The walls located in the infant area was/were not in good condition as evidenced by the walls were not painted after the shelves were removed.
Licensing Rule Reference
5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment 1 (F) states: Walls, ceilings, floors and equipment shall be finished with materials that can be cleaned easily and shall be free of splinters, cracks and chipped paint. Floor covering shall be in good condition. The facility shall be free of all lead hazards and asbestos that is friable or dangerous.
Correction Required
Walls, ceilings, and floors shall be made of approved materials, easily cleaned and in good condition.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's outdoor space was not safe for children's activities as evidenced by the presence of the mats currently being used are non-compliant as they are a tripping hazard for the children as they are observed to be up from the ground in many areas..
Licensing Rule Reference
5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment 4 (C) states: The play area shall be safe for children's activities. It shall be well-maintained and free of hazards such as poisonous plants, broken glass, barbed wire, open wells, rocks and other debris, and shall have good drainage.
Correction Required
The outdoor play area shall be clean, safe and well-maintained as required.

Correction Verification
Return Inspection

Compliance Date

5 CSR 25-300.110 Admission Procedures and Required Reports and Records
Compliance
5 CSR 25-600.020 General Requirements
Compliance
5 CSR 25-600.040 Background Screening Findings
Compliance
RSMo 210.003 Immunizations of children required, when, exceptions--duties of administrator, report--notification of parents, when.
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.
Compliance
RSMo 210.201. Definitions. — As used in sections 210.201 to 210.257, the following terms mean:
Compliance
RSMo 210.254 Religious organization operating facilities exempt under licensing laws required to file parental notice of responsibility and fire, safety inspections annually.
Compliance
RSMo 210.255 Religious organizations operating facility in violation, procedure - noncompliance after notice, prosecutor may act or attorney general.
Compliance
RSMo 252. Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized.
Compliance