5 CSR 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (C) states: Children shall have no access to areas not approved for child care.

Children were not restricted to approved space as evidenced by the storage closet in the school age room was not locked.

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5 CSR 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (3) (A) 4. states: Paper towels, soap and toilet paper shall be provided and easily accessible so the children can reach them without assistance.

Bathroom supplies were not available and accessible to children as evidenced by there was no toilet paper.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (6) (A) 7. states: Areas under and around outdoor equipment shall have continuous maintenance to ensure that the material remains in place and retains its cushioning properties. The resilient material shall be supplemented immediately or replaced as needed.

The fall-zone area under and around outdoor equipment where children might fall and be injured was not covered with impact-absorbing materials to cushion a fall as evidenced by resilient material was not uniformly spread over the fall-zone area.

Open Not marked corrected in the state record

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5 CSR 25-500.092 · 5 CSR 25-500.092 Furniture, Equipment and Materials (3) (A) states: All outdoor equipment shall be constructed safely, in good condition and free of sharp, loose or pointed parts. Only lead-free paint shall be used.

Outdoor equipment, rope climber, in in the playground was not free of sharp parts as evidenced by the rope climber had multiple wooden ladder steps that were broken causing sharp pointed parts .

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5 CSR 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (6) (A) 7. states: Areas under and around outdoor equipment shall have continuous maintenance to ensure that the material remains in place and retains its cushioning properties. The resilient material shall be supplemented immediately or replaced as needed.

The fall-zone area under and around outdoor equipment where children might fall and be injured was not covered with impact-absorbing materials to cushion a fall as evidenced by resilient material was not uniformly spread over the fall-zone area.

Open Not marked corrected in the state record

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5 CSR 25-500.102 · 5 CSR 25-500.102 Personnel (3) (A) states: The center director, group child care home provider, all other caregivers, and those volunteers who are counted in staff/child ratios shall obtain at least twelve (12) clock hours of child-care related training during each calendar year. Clock hour training shall be approved by the department.

The requirements for obtaining 12 clock hours each calendar year were not met. For the calendar year of 2024, the staff listed need the following information: Chloe Axelsen needs 3 hours, Ashley Schmidt needs 2 hours, Kelsey Deluna needs 12 hours, Kaylee Nelson needs 1.5 hours, Tamaira Jameson needs 5 hours, Laiken Heck needs 3 hours, Alyssa Kemper needs 5 hours.

Open Not marked corrected in the state record

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5 CSR 25-500.122 · 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.

Medical examination report(s) was/were not on file for Avah Bayard as evidenced by a medical examination was not on file within 30 days of an individual beginning to work with children.

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5 CSR 25-500.122 · 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.

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: Avah Bayard is no longer employed.

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5 CSR 25-600.020 · 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.

Criminal background check results were not on file for Avah Bayard is no longer employed.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (6) (A) 7. states: Areas under and around outdoor equipment shall have continuous maintenance to ensure that the material remains in place and retains its cushioning properties. The resilient material shall be supplemented immediately or replaced as needed.

The fall-zone area under and around outdoor equipment where children might fall and be injured was not covered with impact-absorbing materials to cushion a fall as evidenced by resilient material was not uniformly spread over the fall-zone area.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-500.092 · 5 CSR 25-500.092 Furniture, Equipment and Materials (3) (D) states: Stationary equipment such as swings, slides and climbers shall be securely anchored, have no exposed footings and be placed to avoid accidents or collisions.

Stationary equipment, helicopter, was unsafe as evidenced by the equipment had exposed footings.

Open Not marked corrected in the state record

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5 CSR 25-500.052 · 5 CSR 25-500.052 Annual Requirements (2) (B) states: Evidence of compliance with local, state, or both, sanitation requirements.

The annual sanitation inspection was not approved.

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5 CSR 25-500.102 · 5 CSR 25-500.102 Personnel (3) (A) states: The center director, group child care home provider, all other caregivers, and those volunteers who are counted in staff/child ratios shall obtain at least twelve (12) clock hours of child-care related training during each calendar year. Clock hour training shall be approved by the department.

The requirements for obtaining 12 clock hours each calendar year were not met. For the calendar year of 2022, the staff listed need the following information: Harley Howell needs 5 hours, Autumn Hunter needs 4 hours, Tamaria Jameson needs 5.5 hours, Cora Morgan needs 1 hour, Kaylee Nelson needs 5 hours, Ashley Schmidt needs 6.5 hours, and Sally Simmons needs 7 hours. As of 4/21/23, Autumn Hunter needs 4 hours, Tamaria Jameson needs 12 hours, Cora Morgan needs 1 hour, needs 5 hours, Ashley Schmidt needs 7.5 hours and Sally Simmons needs 7 hours. As of 8/4/2023 Chloe Axelsen needs 2 hours, Autum Hunter needs 2 hours, Tamaria Jameson needs .50 hours, Kaylee Nelson needs 3 hours, Ashley Schmidt needs 4 hours. As of 1/23/2024, Tamaria Jameson needs .50 hours, Harley Howell, Autumn Hunter and Cora Morgan no longer work at this facility..

Open Not marked corrected in the state record

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5 CSR 25-500.102 · 5 CSR 25-500.102 Personnel (3) (A) states: The center director, group child care home provider, all other caregivers, and those volunteers who are counted in staff/child ratios shall obtain at least twelve (12) clock hours of child-care related training during each calendar year. Clock hour training shall be approved by the department.

The requirements for obtaining 12 clock hours each calendar year were not met. For the calendar year of 2023, the staff listed need the following information: Tamaria Jameson needs 12 hours, Kaylee Nelson needs 0.5 hours, Ashley Schmidt needs 11.75 hours, Sally Simmons needs 6.5 hours and Breanna Crigler needs 1 hour. As of 4/11/2024 Tamaria Jameson needs 12 hours, Kaylee Nelson needs 0.5 hours, Ashley Schmidt needs 5 hours, Sally Simmons needs 6.5 hours and Breanna Crigler needs 1 hour.

Open Not marked corrected in the state record

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5 CSR 25-500.052 · 5 CSR 25-500.052 Annual Requirements (2) (B) states: Evidence of compliance with local, state, or both, sanitation requirements.

The annual sanitation inspection was not conducted.

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5 CSR 25-500.052 · 5 CSR 25-500.052 Annual Requirements (1) (D) states: A current staff sheet.

The staff sheet was not submitted.

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5 CSR 25-500.052 · 5 CSR 25-500.052 Annual Requirements (1) (C) states: A current list of available equipment.

The equipment list was not submitted.

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5 CSR 25-500.102 · 5 CSR 25-500.102 Personnel (3) (A) states: The center director, group child care home provider, all other caregivers, and those volunteers who are counted in staff/child ratios shall obtain at least twelve (12) clock hours of child-care related training during each calendar year. Clock hour training shall be approved by the department.

The requirements for obtaining 12 clock hours each calendar year were not met. For the calendar year of 2022, the staff listed need the following information: Harley Howell needs 5 hours, Autumn Hunter needs 4 hours, Tamaria Jameson needs 5.5 hours, Cora Morgan needs 1 hour, Kaylee Nelson needs 5 hours, Ashley Schmidt needs 6.5 hours, and Sally Simmons needs 7 hours. As of 4/21/23, Autumn Hunter needs 4 hours, Tamaria Jameson needs 12 hours, Cora Morgan needs 1 hour, needs 5 hours, Ashley Schmidt needs 7.5 hours and Sally Simmons needs 7 hours. As of 8/4/2023 Chloe Axelsen needs 2 hours, Autum Hunter needs 2 hours, Tamaria Jameson needs .50 hours, Kaylee Nelson needs 3 hours, Ashley Schmidt needs 4 hours. As of 1/23/2024, Tamaria Jameson needs .50 hours, Harley Howell, Autumn Hunter and Cora Morgan no longer work at this facility..

Open Not marked corrected in the state record

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5 CSR 25-500.102 · 5 CSR 25-500.102 Personnel (3) (A) states: The center director, group child care home provider, all other caregivers, and those volunteers who are counted in staff/child ratios shall obtain at least twelve (12) clock hours of child-care related training during each calendar year. Clock hour training shall be approved by the department.

The requirements for obtaining 12 clock hours each calendar year were not met. For the calendar year of 2023, the staff listed need the following information: Tamaria Jameson needs 12 hours, Kaylee Nelson needs 0.5 hours, Ashley Schmidt needs 11.75 hours, Sally Simmons needs 6.5 hours and Breanna Crigler needs 1 hour.

Open Not marked corrected in the state record

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5 CSR 25-500.122 · 5 CSR 25-500.122 Medical Examination Reports (2) (A) states: The provider, within thirty (30) days following the admission of each infant, toddler or preschool child, shall require a medical examination report signed by a licensed physician or registered nurse who is under the supervision of a 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)form, 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.

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 7/18/22.

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5 CSR 25-500.122 · 5 CSR 25-500.122 Medical Examination Reports (2) (D) states: The parent(s) of a school-age child shall provide a report at the time of enrollment indicating the child's health history, any current health problems, and any restrictions necessary for the child's care.

A school-age child's health report was not on file at the time of enrollment as evidenced by school age health report was not on file for one child.

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5 CSR 25-500.122 · 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.

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: Breanna Crigler, Laiken Heck, Kaylee Nelson.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-500.122 · 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.

Medical examination report(s) was/were not on file for Breanna Crigler as evidenced by a medical examination was not on file within 30 days of an individual beginning to work with children.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-600.020 · 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.

Criminal background check results were not on file for Kaylee Nelson, George Blackwell, Cora Morgan, Christina Kemper, Autumn Hunter and Chloe Axelsen. As of 4/21/23, criminal background check results were not on file for Kaylee Nelson, George Blackwell, Cora Morgan and Autumn Hunter. As of 7/17/23, the criminal background check results were not on file for Kaylee Nelson. As of 1/23/2024 George Blackwell, Cora Morgan and Autumn Hunter no longer work at this facility.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (A) states: The premises shall be safe and suitable for the care of children.

The premises were not safe and suitable as evidenced by unsecured cords were observed hanging from a shelf and beside the water machine in the front room.

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5 CSR 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (A) states: The premises shall be safe and suitable for the care of children.

The premises were not safe and suitable as evidenced by the walls along the bottom of the building on the infant/toddler side of the deck outside had areas that were no longer painted and could be torn off.

Open Not marked corrected in the state record

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5 CSR 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (A) states: The premises shall be safe and suitable for the care of children.

The premises were not safe and suitable as evidenced by an unsecured cord was observed under the television in the infant/toddler unit.

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5 CSR 25-500.052 · 5 CSR 25-500.052 Annual Requirements (2) (C) states: The child care provider shall conduct a Family Care Safety Registry check for all child care staff members within thirty (30) days prior to the anniversary date as printed on the license.

The Family Care Safety Registry check was not conducted for Laiken Heck, Sally Simmons, Cora Morgan, Christina Kemper, Chloe Alexsen, Autum Hunter, Ashley Schmidt, Tamaria Jameson, George Blackwell and Kaylee Nelson within thirty (30) days prior to the anniversary date. As of 4/21/23, the FCSR check was not conducted for Cora Morgan and George Blackwell within thirty (30) days prior to the anniversary date.

Open Not marked corrected in the state record

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5 CSR 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (A) states: The premises shall be safe and suitable for the care of children.

The premises were not safe and suitable as evidenced by 1 spindle leading outside down the first ramp was broken.

Open Not marked corrected in the state record

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5 CSR 25-500.082 · 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.

The floors located in the infant/toddler unit was/were not finished with material which can be cleaned easily as evidenced by there was a 1 inch area in the floor, where the flooring was no longer together, exposing bare wood.

Open Not marked corrected in the state record

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5 CSR 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (6) (A) 4. states: The play area shall be safe for children's activities, well-maintained, free of hazards such as poisonous plants, broken glass, rocks or other debris and shall have good drainage.

The facility's outdoor space was not safe for children's activities as evidenced by grass growing over the resilient material under equipment.

Open Not marked corrected in the state record

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5 CSR 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (6) (A) 7. states: Areas under and around outdoor equipment shall have continuous maintenance to ensure that the material remains in place and retains its cushioning properties. The resilient material shall be supplemented immediately or replaced as needed.

The fall-zone area under and around outdoor equipment where children might fall and be injured was not covered with impact-absorbing materials to cushion a fall as evidenced by resilient material was not uniformly spread over the fall-zone area.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (3) (A) 4. states: Paper towels, soap and toilet paper shall be provided and easily accessible so the children can reach them without assistance.

Bathroom supplies were not available and accessible to children as evidenced by there was no toilet paper.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-500.087 · 5 CSR 25-500.087 Fire Safety (1) (M) states: Means of egress is a continuous and unobstructed way of travel from any point in a building or structure to a public way. A means of egress consists of three (3) distinct parts: the exit access, the exit, and the exit discharge;

The means of egress in the middle room was obstructed in that there was a cot placed against the emergency exit.

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5 CSR 25-500.092 · 5 CSR 25-500.092 Furniture, Equipment and Materials (3) (D) states: Stationary equipment such as swings, slides and climbers shall be securely anchored, have no exposed footings and be placed to avoid accidents or collisions.

Stationary equipment, airplane, was unsafe as evidenced by the equipment had exposed footings.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-500.102 · 5 CSR 25-500.102 Personnel (3) (A) states: The center director, group child care home provider, all other caregivers, and those volunteers who are counted in staff/child ratios shall obtain at least twelve (12) clock hours of child-care related training during each calendar year. Clock hour training shall be approved by the department.

The requirements for obtaining 12 clock hours each calendar year were not met. For the calendar year of 2022, the staff listed need the following information: Harley Howell needs 5 hours, Autumn Hunter needs 4 hours, Tamaria Jameson needs 5.5 hours, Cora Morgan needs 1 hour, Kaylee Nelson needs 5 hours, Ashley Schmidt needs 6.5 hours, and Sally Simmons needs 7 hours. As of 4/21/23, Autumn Hunter needs 4 hours, Tamaria Jameson needs 12 hours, Cora Morgan needs 1 hour, needs 5 hours, Ashley Schmidt needs 7.5 hours and Sally Simmons needs 7 hours.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-500.102 · 5 CSR 25-500.102 Personnel (3) (A) states: The center director, group child care home provider, all other caregivers, and those volunteers who are counted in staff/child ratios shall obtain at least twelve (12) clock hours of child-care related training during each calendar year. Clock hour training shall be approved by the department.

The requirements for obtaining 12 clock hours each calendar year were not met. For the calendar year of 2021, the staff listed need the following information: Sarah Chewning needs 1.5, Virginia (Ginger) Gazaway needs 6 hours, Ashley Schmidt needs 12 hours, Melissa Pearson needs 11 hours, Kacey Hollis needs 1 hour, Tamaria Killpack needs 4 hours, Kayla Person needs 10 hours. As of 4/25/2022, Sarah Chewning, Ginger Gazaway, Melissa Pearson, Kacey Hollis and Kayla Pearson are no longer employed. Ashley Schmidt still needs 12 hours and Tamaria Killpack needs 4 hours. As of 4/21/23, Ashley Schmidt needs 12 hours for 2021.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-500.122 · 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.

Medical examination report(s) was/were not on file for Christina Kemper and Autumn Hunter as evidenced by a medical examination was not on file within 30 days of an individual beginning to work with children.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-500.122 · 5 CSR 25-500.122 Medical Examination Reports (2) (A) states: The provider, within thirty (30) days following the admission of each infant, toddler or preschool child, shall require a medical examination report signed by a licensed physician or registered nurse who is under the supervision of a 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)form, 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.

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 7/18/22.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-500.192 · 5 CSR 25-500.192 Health Care (4) (A) states: No child shall be permitted to enroll in or attend any day care facility caring for ten (10) or more children unless the child has been immunized adequately against vaccine preventable childhood illnesses specified by the department in accordance with recommendations of the Immunization Practices Advisory Committee (ACIP). The parent or guardian of the child shall provide satisfactory evidence of the required immunizations. Satisfactory evidence means a statement, certificate or record from a physician or other recognized health facility or personnel, stating that the required immunizations have been given to the child and verifying the type of vaccine and the month, day and year of administration.

Requirements for immunization reports on file were not met as evidenced by 1 immunization record(s) was/were not on file.

Open Not marked corrected in the state record

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5 CSR 25-500.222 · 5 CSR 25-500.222 Records and Reports (2) (A) states: The child's full name, address, birth-date and the date care begins and ends;

3 child(ren) records did not include date care begins and ends.

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5 CSR 25-500.222 · 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;

1 child(ren) records did not include address of another individual who might be reached in an emergency.

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5 CSR 25-600.020 · 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.

Criminal background check results were not on file for Kaylee Nelson, George Blackwell, Cora Morgan, Christina Kemper, Autumn Hunter and Chloe Axelsen. As of 4/21/23, criminal background check results were not on file for Kaylee Nelson, George Blackwell, Cora Morgan and Autumn Hunter. As of 7/17/23, the criminal background check results were not on file for Kaylee Nelson.

Open Not marked corrected in the state record

Open / not marked corrected.