5 CSR 25-500.222 · 5 CSR 25-500.222 Records and Reports (2) (D) states: Name and phone number of the family physician, hospital, or both, to be used in an emergency;

One child(ren) records did not include telephone number of family physician or hospital.

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5 CSR 25-500.052 · 5 CSR 25-500.052 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 Holly Hoesli, Haley Burger, Sarah Allen, Dustin Hoesli, Avery Hoesli, Skyler Hoesli within thirty (30) days prior to the anniversary date.

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5 CSR 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (2) (A) 8. states: Floor surfaces under indoor equipment over twenty-four inches (24") in height, from which children might fall and be injured, shall be protected with pads or mats which will effectively cushion the fall of a child. Carpeting alone is not an acceptable resilient surface under indoor equipment.

There was no pad or mat under indoor equipment, a slide/climber is 4 ft-4.5 inches high and is located in the back playroom.

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5 CSR 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (2) (A) 2. states: Open windows and doors shall be screened securely. Barriers to prevent children from falling against windows or falling from windows shall be provided when windows are less than twenty-four inches (24") from the floor and not constructed of safety glass or other nonbreakable material.

Window and door requirements were not met as evidenced by the window was located less than 24" from the floor and was not constructed of safety glass or other non-breakable material.

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5 CSR 25-500.102 · 5 CSR 25-500.102 Personnel (4) (A) . states: Every three (3) years, the child care provider, group child care home provider, child care staff members, and volunteers in a group child care home or child care center 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/deseadministrativerules/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 following staff Haley Burger, .

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5 CSR 25-500.122 · 5 CSR 25-500.122 Medical Examination Reports (2) (A) states: The provider, within thirty (30) days following the admission of each infant, toddler or preschool child, shall require a medical examination report signed by a licensed physician or registered nurse who is under the supervision of a 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)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.

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 12/11/2023.

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5 CSR 25-500.222 · 5 CSR 25-500.222 Records and Reports (2) (D) states: Name and phone number of the family physician, hospital, or both, to be used in an emergency;

One child(ren) records did not include name of family physician or hospital.

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5 CSR 25-500.222 · 5 CSR 25-500.222 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;

One child(ren) records did not include address of another individual who might be reached in an emergency.

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5 CSR 25-500.222 · 5 CSR 25-500.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers;

One child(ren) records did not include employers' address of parent(s), guardian or legal custodian.

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5 CSR 25-500.222 · 5 CSR 25-500.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers;

One child(ren) records did not include work telephone number of parent(s), guardian or legal custodian.

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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 Dustin Hoesli, Avery Hoesli, and Skyler Hoesli.

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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 Holly Hoesli.

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5 CSR 25-500.052 · 5 CSR 25-500.052 Annual Requirements (1) (D) states: A current staff sheet.

The staff sheet was not submitted.

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5 CSR 25-500.052 · 5 CSR 25-500.052 Annual Requirements (1) (A) states: An Annual Declaration for Licensed Facility form, revised 2021 and 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, indicating the licensee’s intent to continue operating a licensed group child care home or child care center and agreement to comply with all statutes and department licensing rules.

The Annual Declaration was not submitted.

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5 CSR 25-500.052 · 5 CSR 25-500.052 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 Sarah Allen, Haley Burger, Dustin Hoesli and Holly Hoesli within thirty (30) days prior to the anniversary date.

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5 CSR 25-500.102 · 5 CSR 25-500.102 Personnel (3) (A) states: The center director, group child care home provider, all other caregivers, and those volunteers who are counted in staff/child ratios shall obtain at least twelve (12) clock hours of child-care related training during each calendar year. 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 2023, the staff listed need the following information: Haley Burger needs 5 hours.

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5 CSR 25-500.102 · 5 CSR 25-500.102 Personnel (4) (A) . states: Every three (3) years, the child care provider, group child care home provider, child care staff members, and volunteers in a group child care home or child care center 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/deseadministrativerules/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 following staff Haley Burger and Dustin Hoesli.

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5 CSR 25-500.122 · 5 CSR 25-500.122 Medical Examination Reports (1) (A) states: All persons working in a child care facility in any capacity during child care hours, including volunteers counted in staff/child ratios, shall be in good physical and emotional health with no physical or mental conditions which would interfere with child care responsibilities. These persons shall have a medical examination report, signed by a licensed physician or registered nurse who is under the supervision of a licensed physician, on file at the facility at the time of initial licensure or within thirty (30) days following employment.

Medical examination report(s) was/were not on file for Haley Burger as evidenced by a medical examination was not on file within 30 days of an individual beginning to work with children.

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5 CSR 25-500.122 · 5 CSR 25-500.122 Medical Examination Reports (2) (D) states: The parent(s) of a school-age child shall provide a report at the time of enrollment indicating the child's health history, any current health problems, and any restrictions necessary for the child's care.

A school-age child's health report was not on file at the time of enrollment as evidenced by 2 files were missing this document.

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5 CSR 25-500.192 · 5 CSR 25-500.192 Health Care (4) (A) states: No child shall be permitted to enroll in or attend any day care facility caring for ten (10) or more children unless the child has been immunized adequately against vaccine preventable childhood illnesses specified by the department in accordance with recommendations of the Immunization Practices Advisory Committee (ACIP). The parent or guardian of the child shall provide satisfactory evidence of the required immunizations. Satisfactory evidence means a statement, certificate or record from a physician or other recognized health facility or personnel, stating that the required immunizations have been given to the child and verifying the type of vaccine and the month, day and year of administration.

Requirements for immunization reports on file were not met as evidenced by 2 immunization record(s) was/were not on file.

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5 CSR 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (C) states: Children shall have no access to areas not approved for child care.

Children were not restricted to approved space as evidenced by the Furnace Room (Storage Room) was not locked/latched leaving the space accessible to children.

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5 CSR 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (C) states: Children shall have no access to areas not approved for child care.

Children were not restricted to approved space as evidenced by the basement door to the Family Home was not locked/latched leaving the space accessible to children from the Playground.

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5 CSR 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (I) 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: Shaving Cream, Spray Paint & Modge Podge. The item(s) was/were located in the cabinet (2nd from left) in the middle row & accessible to children.

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5 CSR 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (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 walls located in the "Reading Nook" was/were not in good condition as evidenced by the panel was not secured as the screws were sticking/backing out of the panel.

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5 CSR 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (5) (F) states: Kitchens shall not be used for napping or as passageways for children.

The prohibition to use the kitchen for napping or as a passageway for children was not followed as evidenced by the gates were not secured in place/latched leaving the space accessible to children.

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5 CSR 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (3) (A) 5. states: Locks or latches shall not be used on bathroom or bathroom stall doors used by children below the first grade.

Doors to the bathroom or stalls did not meet requirements as evidenced by there was a lock on the bathroom door.

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5 CSR 25-500.092 · 5 CSR 25-500.092 Furniture, Equipment and Materials (1) (B) 1. A. states: An individual cot or bed 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 11 children 12 months or older, who nap or sleep, did not have a sheet.

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5 CSR 25-500.092 · 5 CSR 25-500.092 Furniture, Equipment and Materials (1) (B) 2. D. 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. Only fitted sheet shall be used and shall be changed immediately when soiled or wet.

Requirements for the crib mattress/playpen padding/bedding were not met as evidenced by a fitted sheet was not used.

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5 CSR 25-500.092 · 5 CSR 25-500.092 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, Little Tykes Playhouse, in the Playground was not in good condition as evidenced by the plastic was cracked to the right of the doorway.

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5 CSR 25-500.122 · 5 CSR 25-500.122 Medical Examination Reports (2) (A) states: The provider, within thirty (30) days following the admission of each infant, toddler or preschool child, shall require a medical examination report signed by a licensed physician or registered nurse who is under the supervision of a 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)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.

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 2/27/2023.

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5 CSR 25-500.182 · 5 CSR 25-500.182 Child Care Program (2) (C) 2. states: Regular snack and meal times according to each infant's individual feeding schedule as stated by the parent(s);

Requirements for infant's feeding schedule were not followed as stated by the parent(s).

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