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;

Two child(ren) records did not include full name, home address, employers name and address, work schedule and home and work telephone numbers of the 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;

Two child(ren) records did not include name, address and telephone number 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 (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 was not in good condition in that there are two broken slats with jagged edges and exposed nails at the bottom of fence on the back playground .

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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 25-500.122 · 5 CSR 25-500.122 Medical Examination Reports (2) (A) states: The provider, within thirty (30) days following the admission of each infant, toddler or preschool child, shall require a medical examination report signed by a licensed physician or registered nurse who is under the supervision of a licensed physician and completed not more than twelve (12) months prior to admission. The provider may use the department’s medical assessment form or the provider may use its own form if it contains all the information on the department’s form. The Child Medical Examination Report (Infant/Toddler/Pre-School)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.

Requirements for infant-toddler/preschool child medical examination reports on file 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 03/27/2024.

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5 CSR 25-500.132 · 5 CSR 25-500.132 Admission Policies and Procedures (8) (E) 8. A. states: They have received a copy of the provider's policies pertaining to the admission, care and discharge of children;

The provider did not have parental acknowledgement on file indicating the parent received a copy of the provider's policies.

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5 CSR 25-500.132 · 5 CSR 25-500.132 Admission Policies and Procedures (8) (E) 8. B. states: They have been informed that the Licensing Rules for Group Day Care Homes and Child Day Care Centers in Missouri are available in the facility for their review;

The provider did not have parental acknowledgement on file indicating the parent has been informed that Licensing Rules for Group Day Care Homes and Child Day Care Centers in Missouri are available for review.

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5 CSR 25-500.132 · 5 CSR 25-500.132 Admission Policies and Procedures (8) (E) 8. C. states: They and the provider have agreed on a plan for continuing communication regarding the child's development, behavior and individual needs;

The provider did not have parental acknowledgement on file indicating the parent and provider have agreed on a plan for continuing communication.

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5 CSR 25-500.132 · 5 CSR 25-500.132 Admission Policies and Procedures (8) (E) 8. D. states: They understand and agree that the child may not be accepted for care when ill.

The provider did not have parental acknowledgement on file indicating the parent understands and agrees that the child may not be accepted for care when ill.

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5 CSR 25-500.132 · 5 CSR 25-500.132 Admission Policies and Procedures (8) (E) 8. E. states: They have received a copy of the provider's safe sleep policy when enrolling children less than one (1) year of age.

The facility did not meet requirements for child enrollment and health information on file as evidenced by one child(s) file did not have the parental acknowledgement they have received a copy of the provider's safe sleep policy.

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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 25-500.102 · 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 Charlene White.

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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 (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 4.5 .

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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 wooden fence next to the big tree had two boards detached at the bottom with exposed sharp nails. The section of chain link fence behind the train should be resecured.

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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: Tounzlanae Glass.

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5 CSR 25-500.222 · 5 CSR 25-500.222 Records and Reports (2) (F) states: Field trip and transportation authorization.

One child(ren) records did not include field trip and transportation authorization.

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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 Renya Murphy did not state if a 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 25-500.122 · 5 CSR 25-500.122 Medical Examination Reports (2) (A) states: The provider, within thirty (30) days following the admission of each infant, toddler or preschool child, shall require a medical examination report signed by a licensed physician or registered nurse who is under the supervision of a licensed physician and completed not more than twelve (12) months prior to admission. The provider may use the department’s medical assessment form or the provider may use its own form if it contains all the information on the department’s form. The Child Medical Examination Report (Infant/Toddler/Pre-School)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.

Requirements for infant-toddler/preschool child medical examination reports on file 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 02/13/2023.

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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;

Two 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) (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;

Two child(ren) records did not include work telephone number 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) (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' name 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) (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;

Three child(ren) records did not include work schedule of parent(s), guardian or legal custodian.

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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 Felicia Lewis, Renya Murphy, Tounzlanae Glass.

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