5 CSR 25-400.125 · 5 CSR 25-400.125 Medical Examination Reports (2) (A) states: The provider shall require, within thirty (30) days following the admission of each infant, toddler or preschool child, a medical examination report signed by a licensed physician or registered nurse who is under the supervision of 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), 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 1/4/2023, 11/14/2022, and 1/8/2024.

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5 CSR 25-400.210 · 5 CSR 25-400.210 Records and Reports (10) states: All records shall be available in the home for inspection by the department upon request.

Records were not available for inspection by the department upon request as evidenced by two children did not have files available for review.

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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 Roxanne Mach, Joanne Tirpak, and Abigail Vogler.

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5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (3) (A) 7. states: The provider shall be responsible for the type, depth and fall-zone area of resilient material necessary for the protection of children.

The provider did not provide resilient material necessary for the protection of children as evidenced by there is bare soil under the slide.

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5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (4) (A) states: Animals which may pose a threat to the health or safety of children shall not be permitted on the premises or shall be penned securely in an area which is inaccessible to the children.

An animal, a 4 kittens and 2 adult cats, which may pose a threat was accessible to the children in care as evidenced by all six cats are stray cats. The children were playing and picking up and holding the kittens.

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5 CSR 25-400.105 · 5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel (4) (A) states: The provider shall obtain at least twelve (12) clock hours of child care-related training during each calendar year. Any assistant who works or volunteers more than five (5) hours per week shall meet the same training requirements. 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: Roxanne Mach and Joanne Tirpak both needs 12 hours .

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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 the steps that lead down into the play space had multiple areas of peeling paint.

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5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (3) (A) 7. states: The provider shall be responsible for the type, depth and fall-zone area of resilient material necessary for the protection of children.

The provider did not provide resilient material necessary for the protection of children as evidenced by more mulch needs to be added under the swings and at the bottom of the slide.

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5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (4) (A) states: Animals which may pose a threat to the health or safety of children shall not be permitted on the premises or shall be penned securely in an area which is inaccessible to the children.

An animal, a 4 kittens and 2 adult cats, which may pose a threat was accessible to the children in care as evidenced by all six cats are stray cats. The children were playing and picking up and holding the kittens.

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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 the documentation on file was not from an approved source.

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5 CSR 25-400.105 · 5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel (4) (A) states: The provider shall obtain at least twelve (12) clock hours of child care-related training during each calendar year. Any assistant who works or volunteers more than five (5) hours per week shall meet the same training requirements. 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: Roxanne Mach and Joanne Tirpak both needs 12 hours .

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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 at least one caregiver certified in first aid/CPR was not on site.

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5 CSR 25-400.175 · 5 CSR 25-400.175 Child Care Program 1 (A) 1 states: Child care providers shall not leave any child without competent adult supervision.

Child(ren) was left without competent adult supervision as evidenced by a 10-month-old was inside asleep inside while all other children and provider and assistant were outside.

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5 CSR 25-400.175 · 5 CSR 25-400.175 Child Care Program 1 (D) 1 states: Infants and toddlers shall have constant care and supervision.

Infants and toddlers did not have constant care and supervision as evidenced by when CI Sims arrived, provider and assistant were outside with the other 9 children, while a 10-month-old was asleep inside.

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