5 CSR 25-500.182 · 5 CSR 25-500.182 Child Care Program (1) (A) 3. states: Caregivers shall provide frequent, direct contact so children are not left unobserved on the premises.

Caregiver did not provide frequent, direct contact as evidenced by CI Cox counted 6 children in the building and staff agreed with that number, then CI Cox counted 9 children on the play yard, and staff on the play yard agreed with this number, however neither group stated they were responsible for the 3 year old child in the bathroom. This bathroom is within a 1 ft of the back door which has a window and one staff person was at this backdoor.

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5 CSR 25-500.182 · 5 CSR 25-500.182 Child Care Program (1) (A) 1. states: Caregivers shall not leave any child without competent supervision.

A child was left without competent supervision as evidenced by as CI Cox was exiting the building to view the play yard, a 3 year old child was in the back bathroom next to the play yard door. There were 2 cargivers in the front of the building with 8 children, and one staff on play yard with 6 other children. The staff on the play yard had allowed the child to re-enter the building to use the restroom. CI Cox observed this staff sitting in a chair facing away from the building, watching the other children on the play yard. CI Cox re-entered the building to discuss this with the director, and on the way back outside, CI Cox noted that the staff on the play yard was sending another child into the building to use the bathroom. The staff person on the play yard stated the children had just woke up, CI Cox asked if she had all the the children use the bathroom before going outside, and was told no. It is highly recommended that all of the children use the bathroom after nap prior to going outside, unless there is an extra staff to supervise the children as they re-enter the bathroom.

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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) 8. states: Concrete, asphalt, carpet, grass or bare soil is not an acceptable surface under outdoor equipment from which children might fall and be injured.

The observed surface area under large blue slide, from which a child might fall consists of bare soil.

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5 CSR 25-500.087 · 5 CSR 25-500.087 Fire Safety (4) (C) 3. states: No door in a means of egress shall be locked against egress travel when the building is occupied. Locking devices that impede or prohibit egress or that cannot be disengaged easily shall not be used. Dead bolt locks that require a key to unlock the door from the inside shall not be used. Locking or latching devices installed on doors shall not be located higher than fifty inches (50") above the finished floor.

The door, located at the facility entrance, used as an exit from the facility was locked.

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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 6 children , ages 9 months to 4-years-old, were cared for by 1 adult caregiver(s).

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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) 8. states: Concrete, asphalt, carpet, grass or bare soil is not an acceptable surface under outdoor equipment from which children might fall and be injured.

The observed surface area under horizontal ladder, from which a child might fall consists of bare soil.

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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 did not state the staff could work with children, was free from contagious disease, was in good physical and emotional health and did not address any limitation or restrictions.

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