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: bottle of floor cleaner and 4 cans of paint. The item(s) was/were located on the floor near the back door.

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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 the black tarp located in the back left corner was bunched up which can result in a tripping hazard.

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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 the resilient material used is unapproved in that the slide located on the deck and the yellow climbing board had foam puzzle pieces as resilient material which is not considered an approved resilient material..

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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 the white gate on the deck has exposed nails/screws that were rusted.

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5 CSR 25-500.092 · 5 CSR 25-500.092 Furniture, Equipment and Materials (1) (B) 2. G states: Cribs, portable cribs and playpens shall be free of soft objects, loose bedding or any object that can increase the risk of entrapment, suffocation or strangulation. Examples include bumper pads, pillows, quilts, comforters, sleep positioning devices, sheepskins, blankets, flat sheets, cloth diapers, bibs, pillow-like toys, wedges, infant positioners, special mattresses, special sleep surfaces, and other similar items.

Soft objects, loose bedding or any object that can increase risk of entrapment, suffocation or strangulation was observed as evidenced by a child aged 6-months-old was sleeping with 2 blankets wrapped around her.

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5 CSR 25-500.092 · 5 CSR 25-500.092 Furniture, Equipment and Materials (1) (B) 2. I states: Sitting devices such as car safety seats, strollers, swings, infant carriers, infant slings, and other sitting devices shall not be used for sleep/nap time. Infants who fall asleep anywhere other than a crib, portable crib, or playpen shall be placed in the crib or playpen for the remainder of their sleep or nap time.

An infant was observed sleeping in a/an bouncer.

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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, the white gate and fence, in the outdoor play space was not in good condition as evidenced by there was peeling paint and paint chippings on the ground..

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5 CSR 25-500.102 · 5 CSR 25-500.102 Personnel (1) (K) . states: The child care provider shall ensure that within seven (7) days of employment or volunteering, and before being left alone with children, that caregivers employed on or after August 30, 2019, receive a facility orientation. The facility orientation shall include--

A facility orientation was not conducted for a caregiver(s) before being left alone with children. The following staff need a facility orientation: Kita Robinson

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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 1 immunization record(s) was/were not on file.

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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 Dlena Lee.

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5 CSR 25-500.052 · 5 CSR 25-500.052 Annual Requirements (1) (B) states: Evidence of compliance with local building and zoning requirements, if applicable.

Evidence of local building approval was not received.

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5 CSR 25-500.212 · 5 CSR 25-500.212 Transportation and Field Trips (2) (A) states: The driver of any vehicle used to transport children shall be no less than eighteen (18) years of age and shall have a valid driver's license as required by Missouri law.

The driver of a vehicle used to transport children was not qualified as evidenced by D'Lena Lee did not have a valid driver's license (Class E or CDL).

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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 25-600.020 · 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 Valerie Burks.

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5 CSR 25-500.052 · 5 CSR 25-500.052 Annual Requirements (1) (B) states: Evidence of compliance with local building and zoning requirements, if applicable.

Evidence of local building approval was not received.

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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 doors to the basement and supply room were left open near the school-age bathrooms.

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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 a power-strip in the preschool classroom did not have protective coverings.

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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 25-500.082 · 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 the chain-link fence was splintered and sharp leading out of 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 (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 the resilient material used is unapproved in that the materials used was colorful interlocking foam squares under the upper-level slide on the porch.

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5 CSR 25-500.092 · 5 CSR 25-500.092 Furniture, Equipment and Materials (1) (B) 1. D. states: Sleeping equipment shall be arranged to provide at least a two foot (2') aisle on one (1) long side of the equipment.

Sleeping equipment was not arranged to provide required spacing as evidenced by there was no aisle on the long side of the napping equipment.

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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 Valerie Perkins.

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5 CSR 25-500.212 · 5 CSR 25-500.212 Transportation and Field Trips (2) (A) states: The driver of any vehicle used to transport children shall be no less than eighteen (18) years of age and shall have a valid driver's license as required by Missouri law.

The driver of a vehicle used to transport children was not qualified as evidenced by D'Lena Lee did not have a valid driver's license (Class E or CDL).

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5 CSR 25-500.222 · 5 CSR 25-500.222 Records and Reports (2) (A) states: The child's full name, address, birth-date and the date care begins and ends;

Two child(ren) records did not include child's full name, address, date of birth and date care begins and ends.

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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) (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 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (2) (B) 1. A. states: At least thirty-five (35) square feet of usable floor space shall be provided for each preschool and school-age child coming into the facility for day care.

The facility did not provide at least 35 square feet of usable floor space for each preschool and school-age child coming into the facility for day care as evidenced by space was reduced by the presence multiple cardboard boxes that were stacked along the wall to the right from the entrance and cleaning supplies within the children’s reach located on the shelving rack to the right of the entrance. The provider stated that the room is not being used currently, but they wanted to continue to use this as child care space. This space was previously measured into usable child care space, but currently is not in any condition to be used by children until the boxes and cleaning supplies are removed.

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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) 1. states: A fenced outdoor play area shall be available on or adjoining the day care property. The play area shall be located so it is convenient and the children can gain access to it without hazard. For facilities initially licensed after the effective date of these rules or for the installation of new fences in existing facilities, the fence shall be at least forty-two inches (42") high. An outdoor play area used exclusively for school-age children shall not be required to have a fence. Fences shall be constructed to prevent children from crawling or falling through or becoming entrapped.

The facility did not have a fenced outdoor play area that was on or adjoining the day care property and was accessible without hazard as evidenced by the fence had openings that were between 3.5 and 9 inches and allow entrapment - the openings measured 5.5 inches in the upper left corner of the playground.

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5 CSR 25-500.122 · 5 CSR 25-500.122 Medical Examination Reports (1) (D) states: The medical examination report form shall be supplied by the department or the facility may use its own form if it contains all the information on the department’s form. The Medical Examination Report for Caregivers and Staff 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.

Medical examination report form did not contain all required information as evidenced by the medical exam form for Tina Perdue does not have the statement signed by the doctor saying that the patient is in good physical and emotional health and free of contagious disease.

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5 CSR 25-500.122 · 5 CSR 25-500.122 Medical Examination Reports (2) (B) states: The examination report shall determine if a child's medical history and current state of health is satisfactory participation in a child care program.

Child's medical examination report did not contain evidence that child’s current health is satisfactory for participation in a child care program.

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5 CSR 25-500.132 · 5 CSR 25-500.132 Admission Policies and Procedures (8) (E) 8. F. states: They have been notified that they may request notice at initial enrollment in or attendance at the facility or upon request of whether there are children for whom an immunization exemption has been filed currently enrolled in or attending the facility

The facility did not meet requirements for child enrollment and health information on file as evidenced by two child(s) file(s) did not have the parental acknowledgement they have been notified that they may request whether there are children for whom an immunization exemption has been filed for currently enrolled in or attending the facility.

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5 CSR 25-500.222 · 5 CSR 25-500.222 Records and Reports (2) (A) states: The child's full name, address, birth-date and the date care begins and ends;

Two child(ren) records did not include date care begins and ends.

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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 25-500.090 · 5 CSR 25-500.090 Disaster and Emergency Preparedness (2) (A) states: At all times, a copy of the facility's disaster and emergency plan is readily available in the office area and in each room used for care of children;

The facility's disaster and emergency plan was not available in each room used for childcare as evidenced by the Preschool/School Age classroom didn't have an emergency plan posted.

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5 CSR 25-500.090 · 5 CSR 25-500.090 Disaster and Emergency Preparedness (2) (B) 1. B. states: A list of emergency numbers, including 911, if available, the fire department, police department, ambulance service, poison control center, and local radio station;

The facility's list of emergency numbers that are posted do not include the numbers for a radio station.

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5 CSR 25-500.090 · 5 CSR 25-500.090 Disaster and Emergency Preparedness (2) (B) 3. states: Any special instructions for infants and non-ambulatory children;

The facility's special instructions for infants and non-ambulatory children were not posted in each room.

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