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 black ground covering exposed, creating tripping hazard.

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5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (3) (A) 8. 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.

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5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (1) (J) states: All flammable liquids, matches, cleaning supplies, poisonous materials, medicines, alcoholic beverages, hazardous personal care items or other hazardous items shall be inaccessible to children.

Hazardous items as follows were accessible to children: diaper creams, inhaler, Clorox wipes. The item(s) was/were located in cubbies and unlocked closet.

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5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (4) (F) states: Food and water dishes used by animals shall not be accessible to the children.

Food and water dishes used by animals were accessible to children as evidenced by dog food and water dish in kitchen.

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5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (4) (F) states: Food and water dishes used by animals shall not be accessible to the children.

Food and water dishes used by animals were accessible to children as evidenced by food and water dishes on kitchen floor.

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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 2024, the staff listed need the following information: Rachel Zorn-needs 5 hours.

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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 March 14, 2024.

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5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (1) (J) states: All flammable liquids, matches, cleaning supplies, poisonous materials, medicines, alcoholic beverages, hazardous personal care items or other hazardous items shall be inaccessible to children.

Hazardous items as follows were accessible to children: Clorox spray, Cascade, Pine Sol, Tide detergent, Raid, and Spectricide. The item(s) was/were located in unlocked cabinet and on low shelf.

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5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (2) (A) 4. states: Artificial or natural lighting shall supply at least ten (10) foot candles of light throughout each room used for child care.

Lighting requirements for rooms used by children were not met as evidenced by the light was not turned on.

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5 CSR 25-400.095 · 5 CSR 25-400.095 Furniture, Equipment and Materials (3) (J) states: Trampolines shall not be used. Mini trampolines, aerobic bouncers or other similar small jumping equipment may be used with close supervision.

Jumping equipment, trampoline was being used.

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5 CSR 25-400.105 · 5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel (1) (J) . states: The child care provider shall ensure that within seven (7) days of employment or volunteering and before being left alone with children, that caregivers employed on or after August 30, 2019, receive a facility orientation. The child care provider shall ensure that documentation verifying completion of the facility orientation is maintained and on file for review by the department for each caregiver. The facility orientation shall include:

A facility orientation was not conducted for a caregiver(s) before being left alone with children. The following staff need a facility orientation: Sarah Miles.

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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 Sarah Miles, who was hired on 5/20/2024.

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5 CSR 25-400.115 · 5 CSR 25-400.115 Child Care Family and Household (4) states: The provider shall notify the department of any new household members.

Provider did not notify the department of a new household member as evidenced by Niece Alana Griesbach and assistant Sarah Miles present during inspection.

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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 infants sleeping in rooms on another level, with no lights, and doors closed.

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5 CSR 25-400.175 · 5 CSR 25-400.175 Child Care Program (1) (E) 1 states: A safe diapering table or other approved area with a waterproof, washable surface shall be used for changing diapers. The table or area shall be cleaned thoroughly with a disinfectant after each use.

The diapering table or other approved area did not have a waterproof surface.

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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 Sarah Miles.

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5 CSR 25-400.055 · 5 CSR 25-400.055 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 25-400.055 · 5 CSR 25-400.055 Annual Requirements (2) (A) states: Evidence of compliance with a fire and safety inspection as conducted by the State Fire Marshal or his/her designee.

The annual fire safety inspection was not conducted.

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5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (1) (J) states: All flammable liquids, matches, cleaning supplies, poisonous materials, medicines, alcoholic beverages, hazardous personal care items or other hazardous items shall be inaccessible to children.

Hazardous items as follows were accessible to children: scissors, batteries, Gillette shaving cream. The item(s) was/were located unlocked drawers.

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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 ceilings located playroom was/were not clean as evidenced by dusty ceiling fan.

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5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (4) (F) states: Food and water dishes used by animals shall not be accessible to the children.

Food and water dishes used by animals were accessible to children as evidenced by dog food and water dishes placed by the back door.

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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 missing outlet covers.

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5 CSR 25-400.095 · 5 CSR 25-400.095 Furniture, Equipment and Materials (1) (B) 2 B states: Cribs and playpens shall meet the Consumer Product Safety Commission and ASTM International (formerly the American Society for Testing and Materials) safety standards for full size baby cribs as found in 16 CFR Part 1219 and for non-full size baby cribs as found in 16 CFR Part 1220. The 2014 crib safety standards found in 16 CFR Parts 1219 and 1220 are incorporated by reference as part of this rule and are published by and available at the U.S. Government Publishing Office, 732 North Capitol Street NW, Washington, D.C. 20401-0001, 202-512-1800, www.bookstore.gpo.gov/catalog/laws-regulations/code-federal-regulations-cfrs-print. This rule does not include any later amendments or additions.

The facility does not have evidence that the crib meets the Consumer Product Safety Commission and ASTM International safety standards.

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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.

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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 a fitted sheet was not used.

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5 CSR 25-400.125 · 5 CSR 25-400.125 Medical Examination Reports (1) (G) states: The medical examination report form shall be supplied by the department or the provider may use his/her own form if it contains all the information on the department's form. The Medical Examination Report for Caregivers and Staff 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.

Medical examination report did not contain all required information as evidenced by missing statement that child is able to participate in child care..

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