5 CSR 25-500.112 · 5 CSR 25-500.112 Staff/Child Ratios (1) (A) states: The staff/child ratio and group size shall be followed as outlined in the below chart unless it meets an exception in subparagraphs (1)(B)-(G) below: Infants, toddlers, and 2-year-olds shall have one caregiver for every four children with no more than eight children per group; Groups composed solely of children 24 to 36 months shall have one caregiver for every eight children with no more than 16 children per group; Groups composed solely of children 3 to 4 years shall have one caregiver for every 10 children with no more than 20 children per group; Groups composed solely of children 5 years or older shall have one caregiver for every 16 children with no more than 32 children per group; A mixed group of children consisting of no more than four children age 2 years, and at least one child older than 3 years shall have one caregiver for every 10 children with no more than 20 children per group; A mixed group of children consisting of more than four children ages 24 to 36 months, and at least one child older than 36 months shall have one caregiver for every eight children with no more than 16 children per group.

Staff/child ratio requirements were not met as evidenced by 15 children , ages 3-years-old to 6-years-old, were cared for by 1 adult caregiver(s).

Open Not marked corrected in the state record

Open / not marked corrected.

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 9/1/2022 and 9/1/2024.

Open Not marked corrected in the state record

Open / not marked corrected.

5 CSR 25-500.222 · 5 CSR 25-500.222 Records and Reports (10) states: All records shall be available in the facility for inspection by the department upon request.

Records were not available for inspection by the department upon request as evidenced by children files were not accessible at inspection.

Open Not marked corrected in the state record

Open / not marked corrected.

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 the air conditioner in the outdoor play space was not enclosed with a barrier to prevent injury to children.

Open Not marked corrected in the state record

Open / not marked corrected.