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 Amanda Rammacher 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 25-300.050 · 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 Amanda Rammacher as evidenced by a cleared TB report was not on file for caregivers within 30 days of working in the facility.

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5 CSR 25-300.090 · 5 CSR 25-300.090 Physical Plant, Space, Supplies and Equipment 1 (B) states: Porches, decks, stairwells or other areas in approved child care space shall have protective handrails and guardrails if there is a drop-off of more than twenty-four inches (24") from which children might fall and be injured. Guardrails shall be at least thirty-six inches (36") high, and shall have bars placed at intervals of no more than three and one-half inches (3 1/2"), or have protective material to prevent a three and one-half inch (3 1/2") sphere from passing through the bars.

The requirements for handrails and guardrails were not met as evidenced by the openings in the handrails measured approximately 7 feet by 11 inches and 12 feet by 14 inches.

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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 has not been conducted.

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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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