5 CSR 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (6) (A) 8. states: Concrete, asphalt, carpet, grass or bare soil is not an acceptable surface under outdoor equipment from which children might fall and be injured.

The observed surface area under swings on a preschool playground, from which a child might fall consists of bare soil.

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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 (4) (A) states: A safe diapering table with a waterproof washable surface shall be used for changing diapers. The diapering table shall be located within or adjacent to the group space so the caregiver using the diapering table can maintain supervision of his/her group of children at all times.

Diapering requirements were not met as evidenced by the diapering table was not located where caregiver could maintain supervision of his/her group of children. The diapering table was located inside the bathroom of Koala's classroom. CI Gerasimova talked with a teacher and moved the diaper changing table out of the bathroom back into a classroom by it's handwashing sink.

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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) 3. states: Toilet and hand washing facilities shall be in working order and convenient for the children's use.

The requirements for toilet and handwashing facilities were not met as evidenced by the hand wash sink was not working.

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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: three spray bottles with bleach water, soapy water and regular water. The item(s) was/were located on the top of the cabinet inside a Koala's preschool bathroom, within children's reach presenting possible poisoning hazards.

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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: various diaper creams. The item(s) was/were located in an unlocked ,easy to pull drawer in Tigers classroom .

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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) (G) states: Protective outlet covers or twist-lock outlets shall be used in areas accessible to the children.

The requirements for protective outlet covers or twist-lock outlets were not met as evidenced by electrical outlets were not covered in that Tigers classroom.

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5 CSR 25-500.092 · 5 CSR 25-500.092 Furniture, Equipment and Materials (2) (C) 1. D. states: Cloth or plastic coated books.

The facility did not meet requirements for cloth or plastic coated books. The facility needed an additional 23 books items in this category.

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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 Gina Esguerra.

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5 CSR 25-500.092 · 5 CSR 25-500.092 Furniture, Equipment and Materials (2) (B) 2. F. states: Music and rhythm activities;

The facility did not meet requirements for music and rhythm activities. The facility needed an additional 33 musical instruments/rhythm toys items in this category.

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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 kitchen door was open and potentially accessible for 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 (6) (A) 4. 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 for children's activities as evidenced by a used wet wipe was found on the playground . It was picked up during the inspection .

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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 (6) (A) 5. states: The fall-zone area under and around outdoor equipment where children might fall and be injured shall be covered with impact absorbing materials which will effectively cushion the fall of a child. This material may include sand, pea gravel, tanbark, shredded tires, wood chips, rubber matting or other approved resilient material.

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 no resilient material was present.

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5 CSR 25-500.087 · 5 CSR 25-500.087 Fire Safety (2) (F) states: Child care staff shall conduct at least one (1) fire drill each month and a disaster drill at least every three (3) months. The disaster drills shall include tornado drills. The provider shall maintain a written record at the facility of the date, type of drill, time required to evacuate the building, and number of children present during the drill.

Requirements of 19 CSR 30-62.087 Fire Safety were not met as evidenced by the evacuation time was not recorded.

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5 CSR 25-500.102 · 5 CSR 25-500.102 Personnel (1) (L) states: The child care provider shall ensure that documentation of caregiver completion of the facility orientation is maintained and on file for review by the department.

Documentation of caregiver completion of the facility orientation was not on file for the following staff: Kierstyn Nemeth, hire date 8/2/2024.

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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 (6) (A) 4. 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 for children's activities as evidenced by an unknown wire loop was out on the IT playground. It looks like a loop that can create potential tripping hazard to the children.

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5 CSR 25-500.122 · 5 CSR 25-500.122 Medical Examination Reports (1) (B) . states: Medical examination reports shall include either a Tuberculosis (TB) Risk Assessment form, completed and signed by a health care professional, or a negative tuberculin skin test (TST) completed not more than twelve (12) months before beginning work in the facility. The Tuberculosis (TB) Risk Assessment form, revised March 2014, is incorporated by reference in this rule, as published by the Missouri Department of Health and Senior Services, PO Box 570, Jefferson City, MO 65102 and available by the Missouri Department of Health and Senior Services at https://health.mo.gov/living/healthcondiseases/communicable/tuberculosis/tbmanual/pdf/RiskAssessmentform.pdf. If the person has signs or symptoms of tuberculosis, or risk factors for tuberculosis, then testing for tuberculosis shall occur.

A medical examination report did not include either a Risk Assessment for Tuberculosis form or a negative tuberculin skin test (TST) for the following staff: Kaitlin Williams.

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