5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (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 kitchen was/were not in good condition as evidenced by small hole in floor.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (3) (A) 9. states: Concrete, asphalt, carpet or bare soil is not an acceptable surface under outdoor equipment from which children might fall and be injured.

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 bare ground observed in the fall zone of the slides, and all climbers.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (3) (A) 6. states: The fall-zone area under and around outdoor equipment where children might fall and be injured shall be covered with impact absorbing materials which effectively cushions the fall of a child. This material may include sand, pea gravel, tanbark, shredded tires, wood chips, rubber matting or other approved resilient material. Grass may be an approved resilient material, but if grass becomes worn or sparse, the area must be covered with another approved resilient material.

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 the resilient material used is unapproved as evidenced by rubber interlocking mats observed in the fall zone of the dome climber, these are not manufactured as resilient surfacing.

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Open / not marked corrected.

5 CSR 25-400.095 · 5 CSR 25-400.095 Furniture, Equipment and Materials (3) (E) states: For family day care homes initially licensed after the effective date of these rules or for homes installing new equipment, any part of the equipment from which children might fall shall not be more than six feet (6') in height.

The outdoor play equipment, plastic rock climbing piece, from which a child might fall was more than six feet in height. The height was 6' 9".

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.185 · 5 CSR 25-400.185 Health Care (6) (B) states: Caregivers shall teach children to wash their hands before eating and after toileting.

Requirements for handwashing were not met as evidenced by snack served to the children during the inspection, no child was instructed to wash their hands.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.185 · 5 CSR 25-400.185 Health Care (6) (A) states: Caregivers shall wash their hands with soap and running water after toileting or assisting a child with toileting, after diapering a child, before food preparation or serving of food and at other times as needed.

Requirements for handwashing were not met as evidenced by caregiver did not wash her had prior to preparing and serving snack.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-600.020 · 5 CSR 25-600.020 General Requirements (5) states: Criminal background checks shall be completed for each child care staff member every five (5) years.

Criminal background check results were older than five (5) years for Candice Keith.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.045 · 5 CSR 25-400.045 Licensing Process (12) states: Once granted, the license shall be posted near the entrance of the home where it may be seen easily by parents or others who visit.

Posting requirements were not met as evidenced by the posted license was outdated.

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Open / not marked corrected.

5 CSR 25-400.055 · 5 CSR 25-400.055 Annual Requirements (1) (B) states: A current list of available equipment.

The equipment list was not submitted.

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Open / not marked corrected.

5 CSR 25-400.055 · 5 CSR 25-400.055 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 Candie Keith, and Gina Miller-Lile within thirty (30) days prior to the anniversary date.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (3) (A) 1. states: An outdoor play area shall be available on or adjoining the day care property. The play area shall be located so it is convenient and the children can gain access to it without hazard. It shall be fenced when necessary for the protection of children from traffic, water or other hazards. For family day care homes initially licensed after the effective date of these rules, or for the installation of new fences in existing facilities, the fence shall be at least forty-two inches (42") high. Fences shall be constructed to prevent children from crawling or falling through or becoming entrapped.

The facility did not have a fenced outdoor play area that was on or adjoining the day care property and was accessible without hazard as evidenced by the fence had openings that were between 3.5 and 9 inches and allow entrapment - the openings measured 5 inches at the bottom of the fence on the northeast corner of the play yard.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (3) (A) 5. 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/well-maintained for children's activities as evidenced by small broken metal pipe with sharp edges was observed in the dome climber which is the fall zone of the play piece.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (3) (A) 9. states: Concrete, asphalt, carpet or bare soil is not an acceptable surface under outdoor equipment from which children might fall and be injured.

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 bare ground inside of the dome climber.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (2) (D) 5. states: Kitchens shall not be used for napping.

Children were observed in the kitchen napping.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.095 · 5 CSR 25-400.095 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, alligator-teetertotter, in play yard was not in good condition as evidenced by missing handle bars.

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Open / not marked corrected.

5 CSR 25-400.210 · 5 CSR 25-400.210 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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Open / not marked corrected.

5 CSR 25-400.105 · 5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel (1) (S) states: The provider shall have documentation on file at the home of current certification in age-appropriate first aid and cardiopulmonary resuscitation (CPR) training. The training shall be certified by a nationally-recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification, include an in-person skills assessment, and be approved by the department. At least one (1) caregiver with current certification in age-appropriate first aid and CPR must be on site at all times when children are present. First aid/CPR training may count toward the annual clock hour training requirement.

The requirements for first aid and CPR certification were not met as evidenced by there was no documentation on file showing completion of age-appropriate CPR certification.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.105 · 5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel (1) (S) states: The provider shall have documentation on file at the home of current certification in age-appropriate first aid and cardiopulmonary resuscitation (CPR) training. The training shall be certified by a nationally-recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification, include an in-person skills assessment, and be approved by the department. At least one (1) caregiver with current certification in age-appropriate first aid and CPR must be on site at all times when children are present. First aid/CPR training may count toward the annual clock hour training requirement.

The requirements for first aid and CPR certification were not met as evidenced by there was no documentation on file showing completion of age-appropriate first aid certification.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.105 · 5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel (5) (A) . states: Every three (3) years the provider, assistant(s), and volunteers in a family child care home 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 dese-administrativerules/incorporated-reference-materials. This rule does not incorporate any subsequent amendments or additions.

Safe sleep training was not completed within the past 3 years for the assistant(s), Gina Lile.

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 Gina Lile.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.086 · 5 CSR 25-400.086 Fire Safety (11) (B) states: Protective covers or inserts for electrical receptacles shall be installed in all areas occupied by children.

The requirements for protective outlet covers were not met as evidenced by three electrical outlets did not have a cover.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.105 · 5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel (1) (S) states: The provider shall have documentation on file at the home of current certification in age-appropriate first aid and cardiopulmonary resuscitation (CPR) training. The training shall be certified by a nationally-recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification, include an in-person skills assessment, and be approved by the department. At least one (1) caregiver with current certification in age-appropriate first aid and CPR must be on site at all times when children are present. First aid/CPR training may count toward the annual clock hour training requirement.

The requirements for first aid and CPR certification were not met as evidenced by there was no documentation on file showing completion of age-appropriate CPR certification.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.105 · 5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel (1) (S) states: The provider shall have documentation on file at the home of current certification in age-appropriate first aid and cardiopulmonary resuscitation (CPR) training. The training shall be certified by a nationally-recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification, include an in-person skills assessment, and be approved by the department. At least one (1) caregiver with current certification in age-appropriate first aid and CPR must be on site at all times when children are present. First aid/CPR training may count toward the annual clock hour training requirement.

The requirements for first aid and CPR certification were not met as evidenced by there was no documentation on file showing completion of age-appropriate first aid certification.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.105 · 5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel (5) (A) . states: Every three (3) years the provider, assistant(s), and volunteers in a family child care home 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 dese-administrativerules/incorporated-reference-materials. This rule does not incorporate any subsequent amendments or additions.

Safe sleep training was not completed within the past 3 years for the assistant(s), Gina Lile.

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 Gina Lile.

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 Gina Lile.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.045 · 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.

The ages of children was/were exceeded as evidenced by one child is 14 years old.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.045 · 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.

The number of children was/were exceeded as evidenced by eleven children were present at the facility.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.095 · 5 CSR 25-400.095 Furniture, Equipment and Materials 1 (B) 2 C states: The crib mattress or playpen pad shall be sized correctly to the crib or playpen, in good condition, waterproof and kept clean and dry, be firm and maintain its shape even when the fitted sheet designated for that model is used, such that there are no gaps between the mattress and the side of the crib or playpen. Only fitted sheets shall be used and shall be changed immediately when soiled or wet.

Requirements for the crib mattress/playpen pad/bedding were not met as evidenced by gaps were observed between the matress/pad and side of the crib or playpen.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.105 · 5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel (1) (P) states: The child care provider shall conduct a Family Care Safety Registry screening prior to employment for any newly hired child care staff member who has a qualifying criminal background check result.

The provider did not conduct a Family Care Safety Registry screening for Gina Lile, who was hired on 11-10-23.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.105 · 5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel (1) (S) states: The provider shall have documentation on file at the home of current certification in age-appropriate first aid and cardiopulmonary resuscitation (CPR) training. The training shall be certified by a nationally-recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification, include an in-person skills assessment, and be approved by the department. At least one (1) caregiver with current certification in age-appropriate first aid and CPR must be on site at all times when children are present. First aid/CPR training may count toward the annual clock hour training requirement.

The requirements for first aid and CPR certification were not met as evidenced by there was no documentation on file showing completion of age-appropriate CPR certification.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.105 · 5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel (1) (S) states: The provider shall have documentation on file at the home of current certification in age-appropriate first aid and cardiopulmonary resuscitation (CPR) training. The training shall be certified by a nationally-recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification, include an in-person skills assessment, and be approved by the department. At least one (1) caregiver with current certification in age-appropriate first aid and CPR must be on site at all times when children are present. First aid/CPR training may count toward the annual clock hour training requirement.

The requirements for first aid and CPR certification were not met as evidenced by there was no documentation on file showing completion of age-appropriate first aid certification.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.105 · 5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel (5) (A) . states: Every three (3) years the provider, assistant(s), and volunteers in a family child care home 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 dese-administrativerules/incorporated-reference-materials. This rule does not incorporate any subsequent amendments or additions.

Safe sleep training was not completed within the past 3 years for the assistant(s), Gina Lile.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.045 · 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.

The number of children was/were exceeded as evidenced by twelve children were present at the facility.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.095 · 5 CSR 25-400.095 Furniture, Equipment and Materials 1 (B) 1 A states: A cot, bed, sofa, padded playpen or crib shall be provided for each child who naps or sleeps. An individually assigned sheet and blanket shall be provided for each child twelve (12) months and older who naps or sleeps. Upper levels of bunk beds shall not be used.

The requirements for sleeping materials were not met as evidenced by 1 children 12 months or older was/were sleeping/napping on the floor.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.095 · 5 CSR 25-400.095 Furniture, Equipment and Materials 1 (B) 2 C states: The crib mattress or playpen pad shall be sized correctly to the crib or playpen, in good condition, waterproof and kept clean and dry, be firm and maintain its shape even when the fitted sheet designated for that model is used, such that there are no gaps between the mattress and the side of the crib or playpen. Only fitted sheets shall be used and shall be changed immediately when soiled or wet.

Requirements for the crib mattress/playpen pad/bedding were not met as evidenced by gaps were observed between the matress/pad and side of the crib or playpen.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.095 · 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.

Soft objects, loose bedding or any object that can increase risk of entrapment, suffocation or strangulation was observed as evidenced by a child age 11 months old in a pack and play with a blanket and pacifier clip.

Open Not marked corrected in the state record

Open / not marked corrected.