5 CSR 25-500.052 · 5 CSR 25-500.052 Annual Requirements (2) (A) states: Evidence of compliance with a fire and safety inspection as conducted by the State Fire Marshal or his/her designee.

The annual fire safety inspection was not conducted.

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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) 2. B. (VI) states: Floors shall be tile, linoleum or wood and shall be mopped and sanitized daily. Washable area rugs that are laundered daily may be used. Centers initially licensed after the effective date of these rules or facilities adding new infant/toddler space shall not use carpet;

Flooring did not meet requirements as evidenced by washable area rugs were not laundered daily.

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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 overgrowth throughout the fence line of the preschool playground, a protruding branch, detached wood pieces in the play area, trash though out the play area, and a rusty water hose holder installed in the wall of the infant/toddler play area and overgrowth on the fence line.

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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 play slide, in the preschool play area was not in good condition as evidenced by it was detached in the play space.

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5 CSR 25-500.212 · 5 CSR 25-500.212 Transportation and Field Trips (2) (B) states: All vehicles used to transport children shall be licensed in accordance with Missouri law.

A vehicle used to transport children was not licensed in accordance with Missouri law.

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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 Christian Neil, LaTresha Neil, and Crystal Crowder.

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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 the preschool classroom located downstairs near the kitchen.

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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 two cribs had loose fitting sheets.

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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) 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 floors located in the preschool classroom in the basement was/were not in good condition as evidenced by 10 broke/chipped tiles.

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5 CSR 25-500.092 · 5 CSR 25-500.092 Furniture, Equipment and Materials (1) (C) 2. states: Infants and toddlers. Infants and toddlers who are unable to sit at a table shall have one (1) piece of mealtime feeding equipment for every four (4) infant/toddlers which may include feeding tables, high chairs, infant seats or other safely designed infant seating equipment. Equipment shall be provided which will allow the child to sit comfortably and securely while being fed. Appropriate restraints shall be used.

Requirements for feeding equipment for infants and toddlers who are unable to sit at a table were not met as evidenced by the restraints were not available.

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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 Crystal Crowder.

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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 Aniua Walters.

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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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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 zoning 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) (A) states: The premises shall be safe and suitable for the care of children.

The premises were not safe and suitable as evidenced by a closet door in the preschool room downstairs was unlocked and had a open drain which was exposed and accessible to children..

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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) 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 floors located in the back downstairs preschool room was/were not in good condition as evidenced by there was less than an inch of standing water in parts of the room from the rain. The director stated this was from the sewage system coming up through the floor when it rains.

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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 are not posted in each room used for child care, specifically all rooms.

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5 CSR 25-500.090 · 5 CSR 25-500.090 Disaster and Emergency Preparedness (2) (B) 2. states: A diagram of evacuation routes from the room;

The facility's evacuation route diagram was not posted in each room.

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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 zoning approval was not received.

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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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5 CSR 25-500.082 · 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (A) states: The premises shall be safe and suitable for the care of children.

The premises were not safe and suitable as evidenced by a closet door in the preschool room downstairs was unlocked and had a open drain which was exposed and accessible to children..

Open Not marked corrected in the state record

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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 preschool room downstairs.

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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) (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: Lysol cans. The item(s) was/were located in the preschool girls bathroom downstairs and 2-year-old bathroom upstairs.

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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) 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 floors located in the back downstairs preschool room was/were not in good condition as evidenced by there was less than an inch of standing water in parts of the room from the rain. The director stated this was from the sewage system coming up through the floor when it rains.

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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) (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: cleaning vinegar. The item(s) was/were located in the pantry on the floor downstairs.

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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) (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: standing water in the mop bucket. The item(s) was/were located in the pantry downstairs.

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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 are not posted in each room used for child care, specifically all rooms.

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5 CSR 25-500.090 · 5 CSR 25-500.090 Disaster and Emergency Preparedness (2) (B) 2. states: A diagram of evacuation routes from the room;

The facility's evacuation route diagram was not posted in each room.

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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 zoning approval was not received.

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5 CSR 25-500.052 · 5 CSR 25-500.052 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 Crystal Crowder within thirty (30) days prior to the anniversary date.

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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) 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 floors located downstairs was/were not in good condition as evidenced by there was a tile missing near the dramatic play area.

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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) 9. states: The facility shall be clean at all times and free of dirt, insects, spiders, rodents or other pests.

There was evidence of dirt/debris in there was a black residue build-up on the white cabinets in the middle preschool classroom and on the I/T door near the handle on both side.

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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 (4) (A) states: A safe diapering table with a waterproof washable surface shall be used for changing diapers. The diapering table shall be located within or adjacent to the group space so the caregiver using the diapering table can maintain supervision of his/her group of children at all times.

Diapering requirements were not met as evidenced by there was no diapering table within the group space.

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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) 6. states: The provider shall be responsible for the type, depth and fall-zone area of resilient material necessary for the protection of children.

The provider did not provide resilient material necessary for the protection of children as evidenced by the padding under the I/T slide is not 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 (3) (A) 7. states: Bathrooms shall be clean and odor free.

The bathroom was not clean and odor free as evidenced by the toilet was soiled.

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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) 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 floors located downstairs girls restroom was/were not in good condition as evidenced by there were multiple tiles missing.

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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) 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 middle preschool classroom was/were not in good condition as evidenced by the 1/2 door had chipping paint at the top and bottom. There was also chipping paint along the arch way.

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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) 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 at the door at the top of the steps was/were not in good condition as evidenced by there was a quarter sized hole towards the bottom of the door.

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5 CSR 25-500.092 · 5 CSR 25-500.092 Furniture, Equipment and Materials (1) (A) 1. states: All furniture and equipment shall be constructed safely, in good condition and free of sharp, loose or pointed parts. Only lead-free paint shall be used.

Furniture/equipment, foam puzzle play mat, in the 1st preschool classroom was not in good condition as evidenced by there were multiple dime size circular holes.

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5 CSR 25-500.102 · 5 CSR 25-500.102 Personnel (1) (L) states: The child care provider shall ensure that documentation of caregiver completion of the facility orientation is maintained and on file for review by the department.

Documentation of caregiver completion of the facility orientation was not on file for the following staff: Lena Anderson and Saprina Cooksey.

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5 CSR 25-500.102 · 5 CSR 25-500.102 Personnel (1) (T) states: The licensee shall have documentation on file at the facility of current certification in age-appropriate first aid and cardiopulmonary resuscitation (CPR) training for a sufficient number of child care staff to ensure that there is one (1) caregiver at the facility for every twenty (20) children in the licensed capacity. At least one (1) caregiver with current certification in age-appropriate first aid and CPR must be on site at all times when children are present. The training shall be certified by a nationally-recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification, include an in-person skills assessment, and be approved by the department.

The requirements for first aid/CPR were not met as evidenced by there was no documentation on file showing completion of age-appropriate first aid certification for the requested/licensed capacity.

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5 CSR 25-500.102 · 5 CSR 25-500.102 Personnel (4) (A) 3. states: The child care provider, group child care home provider, child care staff members, and volunteers shall complete safe sleep training described in subsection (4)(A) of this rule within thirty (30) days of employment or volunteering at the facility.

Arielle Durgins did not complete safe sleep training within 30 days of employment or volunteering at the facility.

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5 CSR 25-500.122 · 5 CSR 25-500.122 Medical Examination Reports (1) (A) states: All persons working in a child care facility in any capacity during child care hours, including volunteers counted in staff/child ratios, shall be in good physical and emotional health with no physical or mental conditions which would interfere with child care responsibilities. These persons shall have a medical examination report, signed by a licensed physician or registered nurse who is under the supervision of a licensed physician, on file at the facility at the time of initial licensure or within thirty (30) days following employment.

Medical examination report(s) was/were not on file for Lena Anderson (yes/no), Saprina Cooksey, Thelma Dozier, Kayla Morgan, Jelyzza Whitaker, and Chelsea Williams 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 25-500.122 · 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: Saprina Cooksey, Thelma Dozier, Kayla Morgan, and Jelyzza Whitaker.

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5 CSR 25-500.182 · 5 CSR 25-500.182 Child Care Program (1) (E) 7. states: The diapering area and hand washing area shall be separate from any food service area and any food-related materials.

Separation requirements of diapering/hand wash areas from food service were not met as evidenced by food was prepared at the hand sink.

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5 CSR 25-500.202 · 5 CSR 25-500.202 Nutrition and Food Service (2) (B) states: The written diet plan for each infant/toddler shall be followed. The parent(s) shall update the plan according to the individual needs of the child until they grant permission in writing for the child to eat table foods.

The provider did not meet requirements for a written diet plan for each infant and toddler as evidenced by the written diet plan was not updated for a child in that Child A needs the 12-23 months section completed.

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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;

3 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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