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 the medical examination report for Ruth Martin did not have the box checked indicating the individual is in good physical and emotional health and free of contagious disease..

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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 2 as evidenced by the medical examination was not signed by the required medical source.

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5 CSR 25-300.050 · 5 CSR 25-300.050 Health Requirements (2) states: Within thirty (30) days following the admission of an infant, toddler or preschool child, a physical assessment report signed by a licensed physician or registered professional nurse shall be on file at the facility. The facility may use the department's physical assessment form, MO 580-1878 (6-94), or the facility may use its own form if it contains all the information on the department's form. The report shall have been completed not more than twelve (12) months before admission.

Requirements for children's medical examination reports 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 7/1/24, 12/23/24, 8/1/24.

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5 CSR 25-300.090 · 5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment 2 (E) states: At least thirty-five (35) square feet of usable floor space for each preschool and school-age child, and at least forty-five (45) square feet of usable floor space for each infant/toddler.

The facility did not provide 45 square feet of usable floor space for each child coming into the facility for day care as evidenced by there was a 23-months-old present during the time of the inspection and this facility is not approved for infant/toddler care.

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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 4 (E) states: Outdoor play space for infants and toddlers separate from that used for older children, or the same space used at different times. This does not apply to facilities caring for a maximum of twenty (20) children, including no more than four (4) infant/toddlers.

The facility's outdoor play space is used at the same time by children from the infant/toddler unit and preschool/school-age children as evidenced by there was a 23-months-old present during the time of the inspection and this facility is not approved for infant/toddler care. The 23-month-old child goes outside with the 2-year-old children.

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5 CSR 25-300.110 · 5 CSR 25-300.110 Admission Procedures and Required Reports and Records 2 (A) states: The child's full name, address, birth date and the date care begins and ends.

The facility did not meet requirements for child enrollment and health information on file as evidenced by 1 child files did not have the child’s full name, address, birth date and the date care begins and ends.

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5 CSR 25-300.110 · 5 CSR 25-300.110 Admission Procedures and Required Reports and Records 2 (B) states: The full name of the parent(s), guardian or legal custodian, home address, work schedule, home and work telephone numbers, and employer's name and address.

The facility did not meet requirements for child enrollment and health information on file as evidenced by 7 child files did not have the full name of the parent(s), guardian or legal custodian, home address, employers’ name and address, work schedule and home and work telephone numbers.

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5 CSR 25-300.110 · 5 CSR 25-300.110 Admission Procedures and Required Reports and Records 2 (C) states: Full name, address and phone number of a friend or relative who might be reached in an emergency when a parent, guardian or legal custodian cannot be reached.

The facility did not meet requirements for child enrollment and health information on file as evidenced by 3 child files did not have the name, address and telephone number of another individual (friend or relative) who might be reached in an emergency.

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5 CSR 25-300.110 · 5 CSR 25-300.110 Admission Procedures and Required Reports and Records 2 (D) states: Name and phone number of a physician and preferred hospital to be used in an emergency.

The facility did not meet requirements for child enrollment and health information on file as evidenced by 5 child files did not have the name and phone number of the family physician, or hospital, or both.

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RSMo 210.254 Religious organization operating facilities exempt under licensing laws required to file parental notice of responsibility and fire, safety inspections annually. 2. (3) states: The staff/child ratios for enrolled children under two years of age, for children ages two to four and for those five years of age and older as required by the department of elementary and secondary education regulations in licensed facilities, the standard ratio of staff to number of children for each age level maintained in the exempt facility, and the total number of children to be enrolled by the facility.

Staff/child ratios did not meet those set forth in the Notice of Parental Responsibility.

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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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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 sanitation inspection were not met as evidenced by the inspection was not approved.

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