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 medical exam forms for Crystal Mendoza and Sydney Serrano not completely filled out.

Open Not marked corrected in the state record

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5 CSR 25-300.050 · 5 CSR 25-300.050 Health Requirements (1) (D) . states: All caregivers working in a facility during child care hours shall be in good health. They shall have a physical assessment, including a tuberculosis status assessment by a licensed physician or registered professional nurse. A physical assessment report, signed by a licensed physician or registered professional nurse, shall be on file at the time of employment or within thirty (30) days following employment.

Medical examination reports, including TB testing, were not on file for Emma Hoffman 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

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5 CSR 25-300.090 · 5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment 2 (F) 2 states: A facility with a capacity of more than twenty (20) children or more than four (4) infants and toddlers shall have infant and toddler space separate from the older children. The space shall be separated by floor to- ceiling walls with separate play, sleeping and bathroom space.

The space for infants and toddlers is not separated by floor-to-ceiling walls.

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5 CSR 25-300.090 · 5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment 5 (A) states: An individual mat, cot or bed with an individually assigned sheet and blanket provided for each child who naps or sleeps. Upper levels of bunk beds shall not be used. If mats are used they shall have nonabsorbent, cleanable coverings and shall not be placed directly on concrete, linoleum, hardwood, or tile floors when children are resting or napping. They shall be used only over carpeting and shall be long enough so the child's head or feet do not rest off the mat. Mats shall be washed and sanitized at least weekly, or more often as needed, and shall be cleaned and sanitized before use by another child.

The facility failed to meet requirements for 25 children, who nap or sleep, did not have a sheet.

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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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5 CSR 25-300.050 · 5 CSR 25-300.050 Health Requirements (1) (D) 1. states: Physical assessment reports shall be completed not more than twelve (12) months before beginning work in the facility. The reports may be transferred to another facility for future employment.

Medical examination reports including TB testing were not on file for caregivers as evidenced by the medical examination on file is older than 12 months before the individual's begin date at the facility.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-300.050 · 5 CSR 25-300.050 Health Requirements (1) (D) 1. states: Physical assessment reports shall be completed not more than twelve (12) months before beginning work in the facility. The reports may be transferred to another facility for future employment.

Medical examination reports including TB testing were not on file for caregivers as evidenced by a TB report on file is older than 12 months before the individual's begin date at the facility.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-300.050 · 5 CSR 25-300.050 Health Requirements (1) (D) . states: All caregivers working in a facility during child care hours shall be in good health. They shall have a physical assessment, including a tuberculosis status assessment by a licensed physician or registered professional nurse. A physical assessment report, signed by a licensed physician or registered professional nurse, shall be on file at the time of employment or within thirty (30) days following employment.

Medical examination reports, including TB testing, were not on file for Jessie Coult 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 25-300.090 · 5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment 1 (F) states: Walls, ceilings, floors and equipment shall be finished with materials that can be cleaned easily and shall be free of splinters, cracks and chipped paint. Floor covering shall be in good condition. The facility shall be free of all lead hazards and asbestos that is friable or dangerous.

The walls located in downstairs hallway (storage door) was/were not in good condition as evidenced by wood splintering.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-300.090 · 5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment 1 (F) states: Walls, ceilings, floors and equipment shall be finished with materials that can be cleaned easily and shall be free of splinters, cracks and chipped paint. Floor covering shall be in good condition. The facility shall be free of all lead hazards and asbestos that is friable or dangerous.

The ceilings located in rooms 203, 101, 104, 105 and hallway near upstairs bathrooms was/were not easily cleanable as evidenced by dusty vents.

Open Not marked corrected in the state record

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5 CSR 25-300.090 · 5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment 7 states: Indoor play equipment and materials shall be provided and shall be clean and in good condition with all parts intact. Infants and toddlers shall have safe toys. Toys, parts of toys or other materials small enough to be swallowed shall not be used.

Requirements for indoor play equipment and materials were not met. Toys/materials were not in good condition as evidenced by sticky residue on shelves in rooms 104 and 107.

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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 between 4.5" and 8.5" (between wooden gate and concrete and around meter).

Open Not marked corrected in the state record

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