5 CSR 25-300.050 · 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.

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 the medical provider failed to mark whether or not the patient was in good physical & emotional health & free of contagious disease for the following caregivers: Caren Pruitt.

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5 CSR 25-300.050 · 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.

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 a Sports Physical was on file for Abigail Holland.

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5 CSR 25-300.050 · 5 CSR 25-300.050 Health Requirements (2) states: Within thirty (30) days following the admission of an infant, toddler or preschool child, a physical assessment report signed by a licensed physician or registered professional nurse shall be on file at the facility. The facility may use the department's physical assessment form, MO 580-1878 (6-94), or the facility may use its own form if it contains all the information on the department's form. The report shall have been completed not more than twelve (12) months before admission.

Requirements for children's medical examination reports 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 4/18/2023 & 8/21/2023.

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5 CSR 25-300.090 · 5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment 1 (D) states: Hazardous materials such as cleaning supplies, poisonous materials, medicines, alcoholic beverages or hazardous personal care items shall be inaccessible to children and stored to prevent cross-contamination of food and food-related materials.

Hazardous items as follows were accessible to children: Bleach, Sanitizer Spray, Toilet Bowl Cleaner (4 bottles of each). The item(s) was/were located in the Girls Bathroom in the Cave Building.

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5 CSR 25-300.090 · 5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment 1 states: The premises of all facilities shall be safe and suitable for the care of children.

The premises were not safe and suitable as evidenced by a bolt was exposed at the bottom of the second post to the right of the corner there the 2 Playgrounds join on the fence surrounding the "Upper" Playground located at child height.

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5 CSR 25-300.090 · 5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment 1 states: The premises of all facilities shall be safe and suitable for the care of children.

The premises were not safe and suitable as evidenced by 2 boards at the bottom of the fence were not secured to the fence & had exposed screws. The first board was located at the bottom of the first panel to the left of the corner where the 2 Playgrounds join & the second board was located at the bottom of the second panel to the right of the same corner.

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5 CSR 25-300.090 · 5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment 4 (A) states: An outdoor play area available on or adjoining the child care property. Facilities with a capacity of more than ten (10) children shall have a fenced play area. Play areas in facilities with a capacity of ten (10) or fewer children shall be fenced when necessary for the protection of children from traffic, water or other hazards. Fences shall be at least forty-two inches (42") high. Openings in fences shall be no greater than three and one-half inches (3 1/2").

Requirements for the outdoor play area were not met as evidenced by the fence had openings that were greater than 3 1/2 inches and allow entrapment - the openings measured 5 inches at the corner right next to the building to the left of the gate.

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5 CSR 25-300.090 · 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.

The facility's outdoor space was not safe for children's activities as evidenced by the presence of a Propane Patio Heather was located on the concrete under the awning on the Playground.

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RSMo 252. Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized. 1. states: All buildings and premises used by a child-care facility to care for more than six children except those exempted from the licensing provisions of the department of elementary and secondary education pursuant to subdivisions (1) to (15) of subsection 1 of section 210.211, shall be inspected annually for fire and safety by the state fire marshal, the marshal's designee or officials of a local fire district and for health and sanitation by the department of elementary and secondary education or the department's designee, including officials of the department of health and senior services, or officials of the local health department. Evidence of compliance with the inspections required by this section shall be kept on file and available to parents of children enrolling in the child-care facility.

Requirements for fire safety inspection were not met as evidenced by the inspection was not approved.

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