DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

INSPECTION REPORT
Facility Information






 




 








 
Inspection Information








DocumentDocument-Date
SAMPLE WEEKLY MENU 09/09/2024
SAFE SLEEP POLICY 08/18/2024
REGISTERING FICTITIOUS NAMES 09/16/2024
SANITATION INSPECTION 04/01/2025
FIRE/SAFETY INSPECTION 03/31/2025
POLICIES 09/12/2024
LOCAL ZONING APPROVAL 09/19/2024
LOCAL BUILDING APPROVAL 09/19/2024
LLC OPERATING AGREEMENT 09/12/2024
LLC ARTICLES OF ORGANIZATION 09/12/2024
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 03/27/2025
LINES OF ADMINISTRATIVE AUTHORITY 03/27/2025
LICENSING ORIENTATION 04/19/2022
JOB RESPONSIBILITIES 09/12/2024
EQUIPMENT LIST 03/27/2025
DISCIPLINE POLICIES 09/01/2024
DISASTER AND EMERGENCY PREPAREDNESS PLAN 03/27/2025
DIRECTOR'S QUALIFICATIONS 09/09/2024
DIAGRAM/OUTDOOR 09/18/2024
DIAGRAM/INDOOR 09/18/2024
DAILY SCHEDULE 03/27/2025
CHILD CARE PRACTICES 09/12/2024
APPLICATION 02/17/2025




Compliance Licensing Rules
Open Violations:
NOTE
The licensee is responsible for compliance with all licensing rules, including but not limited to the rules listed on this compliance report form.

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
Violation
 Provider Comments
Violation
A caregiver did not obtain a Missouri Professional Development Identification (MOPD ID) number. The staff listed need a MOPD ID: Cindy Johnson, Samantha Charleyville, Hadley Bouyoukos, Katie Boucher & Haley Benthall.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (3) (F) 1. states: Caregivers shall obtain a Missouri Professional Development Identification (MOPD ID) number from the department.
Correction Required
All caregivers shall obtain a MOPD ID.

Correction Verification
Submit Documentation

Compliance Date

Violation
Safe sleep training was not completed within the past 3 years for the following staff Cindy Johnson, Samantha Charleyville & Hadley Bouyoukos.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (4) (A) . states: Every three (3) years, the child care provider, group child care home provider, child care staff members, and volunteers in a group child care home or child care center licensed to provide care for infants less than one (1) year of age shall successfully complete department-approved training regarding the American Academy of Pediatrics (AAP) safe sleep recommendations contained in the American Academy of Pediatrics Policy Statement on sleep-related infant deaths. The Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment, July 2022, is incorporated by reference in this rule, as published by the American Academy of Pediatrics and available at https://publications.aap.org/pediatrics/article/150/1/e2022057990/188304/Sleep-Related-Infant-Deaths-Updated-2022 or as published in PEDIATRICS Volume 150, Issue 1, July 2022. A copy can also be obtained from the Department of Elementary and Secondary Education, Office of Childhood, 205 Jefferson Street, PO Box 480, Jefferson City, MO 65102-0480 and at https://dese.mo.gov/governmental-affairs/deseadministrativerules/incorporated-reference-materials. This rule does not incorporate any subsequent amendments or additions.
Correction Required
The director, group home provider, other caregivers, and those volunteers counted in staff/child ratio, shall complete department-approved safe sleep training as required.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-500.112 Staff/Child Ratios
Compliance
5 CSR 25-500.122 Medical Examination Reports
Violation
 Provider Comments
Violation
Medical examination report(s) was/were not on file for Cindy Johnson, Samantha Charleyville & Hadley Bouyoukos 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 25-500.122 Medical Examination Reports (1) (A) states: All persons working in a child care facility in any capacity during child care hours, including volunteers counted in staff/child ratios, shall be in good physical and emotional health with no physical or mental conditions which would interfere with child care responsibilities. These persons shall have a medical examination report, signed by a licensed physician or registered nurse who is under the supervision of a licensed physician, on file at the facility at the time of initial licensure or within thirty (30) days following employment.
Correction Required
Medical reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

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: Cindy Johnson, Samantha Charleyville & Hadley Bouyoukos.
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
Submit Documentation

Compliance Date

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
Violation
 Provider Comments
Violation
Handwashing requirements were not met as evidenced by a caregiver did not wash his/her hands with soap and water after changing a child's diaper.
Licensing Rule Reference
5 CSR 25-500.182 Child Care Program (1) (E) 6. states: Caregivers changing diapers shall wash their hands with soap and running water each time after changing a child's diaper.
Correction Required
Caregivers shall wash their hands after each diaper change.

Correction Verification
Corrected on Site

Compliance Date
7/14/2025
5 CSR 25-500.192 Health Care
Violation
 Provider Comments
Violation
Requirements for handwashing were not met as evidenced by 1 child's hand were not washed after they were diapered.
Licensing Rule Reference
5 CSR 25-500.192 Health Care (6) (B) states: Caregivers shall teach children to wash their hands before eating and after toileting.
Correction Required
Staff/children shall wash hands as required.

Correction Verification
Corrected on Site

Compliance Date
7/14/2025
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
Violation
 Provider Comments
Violation
Criminal background check results were not on file for Cindy Johnson, Samantha Charleyville, Hadley Bouyoukos, Katie Boucher & Haley Benthall.
Licensing Rule Reference
5 CSR 25-600.020 General Requirements (1) states: Prior to the employment or presence of a child care staff member in a licensed, regulated, or registered child care facility not exempted by section 210.1080.13, RSMo, the child care provider shall request the results of a criminal background check for such child care staff member from the department.
Correction Required
Required results of criminal background checks shall be on file.

Correction Verification
Submit Documentation

Compliance Date

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