5 CSR 25-400.190 · 5 CSR 25-400.190 Nutrition and Food Service (1) (A) states: The provider shall supply and serve nourishing food according to the Meal and Snack Food Chart provided in this rule.

The provider did not supply and serve food according to the Meal and Snack Food Chart as evidenced by Milk was not present at the meal and the milk in the refrigerator was outdated..

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.055 · 5 CSR 25-400.055 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 Wayne Nicholsen and Madeline Shook within thirty (30) days prior to the anniversary date.

Open Not marked corrected in the state record

Open / not marked corrected.

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 Wayne Nicholsen and Madeline Shook.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.095 · 5 CSR 25-400.095 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, most all the toys, in the playground was not in good condition as evidenced by dirt and dust were covering them.

Open Not marked corrected in the state record

Open / not marked corrected.

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: toilet bowl cleaner. The item(s) was/were located by the toilet bowl in reach of children.

Open Not marked corrected in the state record

Open / not marked corrected.

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 walls located in all the rooms- the trim and base boards at the home was/were not in good condition as evidenced by peeling and chipping paint is observed on the baseboard and trim in the entire home. The trim between the kitchen and the adjoining room and the bathroom trim on the doorway to bathroom.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (2) (A) 9. states: The home shall be clean at all times and free of dirt, insects, spiders, rodents or other pests.

There was evidence of dirt/debris in the kitchen floor was dirty with wood chips, wrappers, paper and there is food on the area rug under the kitchen table. The front door to the kitchen is covered with dirt and grime.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (2) (A) 9. states: The home shall be clean at all times and free of dirt, insects, spiders, rodents or other pests.

There was evidence of dirt/debris in kitchen trash can is covered with dried food and dirt and grime.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (2) (C) 1. E. states: Bathrooms shall be clean and odor free.

The bathroom was not clean and odor free as evidenced by there is dirt and grime on the floor and around and behind the stool.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (2) (C) 1. E. states: Bathrooms shall be clean and odor free.

The bathroom was not clean and odor free as evidenced by the toilet bowl rim was observed to have dried urine on it and there is a urinal attached to the door of the bathroom.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (2) (C) 1. E. states: Bathrooms shall be clean and odor free.

The bathroom was not clean and odor free as evidenced by there are towels pushed under a board by the bathtub which appear to be stuffing a hole or gap between the tub and the floor.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.085 · 5 CSR 25-400.085 Physical Requirements of the Family Day Care Home (2) (C) 1. E. states: Bathrooms shall be clean and odor free.

The bathroom was not clean and odor free as evidenced by there are clothes, a changing table, card board, diapers, and clothing thrown in the bathtub.

Open Not marked corrected in the state record

Open / not marked corrected.

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 the mattress/pad was not in good condition in that the pack and play base board that had the mattress attached was broken and was floppy and sinking.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.095 · 5 CSR 25-400.095 Furniture, Equipment and Materials (3) (D) states: Stationary equipment such as swings, slides and climbers shall be securely anchored, have no exposed footings and be placed to avoid accidents or collisions.

Stationary equipment, the swing set, was unsafe as evidenced by the equipment was not securely anchored.

Open Not marked corrected in the state record

Open / not marked corrected.

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 the swing set was not anchored into the ground.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.185 · 5 CSR 25-400.185 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 adequately immunized against vaccine preventable childhood illnesses specified by the department in accordance with recommendations of 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 one immunization record(s) was/were not on file .

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.185 · 5 CSR 25-400.185 Health Care (4) (B) 1. states: Satisfactory evidence is produced that the child has begun the process of immunization. The child may continue to attend as long as the immunization process is being accomplished according to the ACIP/Missouri Department of Health recommended schedule.

There was no evidence that the one child(ren) had begun the immunization process.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.185 · 5 CSR 25-400.185 Health Care (4) (B) 2. A. states: A medical exemption by which the child shall be exempted from immunization requirements upon certification by a licensed physician that the immunization would seriously endanger the child's health or life.

There was no certification by a licensed physician for a medical exemption on file for one child child(ren).

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.185 · 5 CSR 25-400.185 Health Care (4) (B) 2. B. states: A parent or guardian exemption by which a child shall be exempted from immunization requirements if one (1) parent or guardian files a written objection to immunization with the day care administrator. Exemptions shall be accepted by the day care administrator when the necessary information as determined by the department is filed with the day care administrator by the parent or guardian. Exemption forms shall be provided by the department.

There was no parental written objection to immunizations on file for one child child(ren).

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-400.210 · 5 CSR 25-400.210 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 name, address and telephone number of another individual who might be reached in an emergency.

Open Not marked corrected in the state record

Open / not marked corrected.