Discovery Daycare And Preschool

5 CSR 25-500.112 Staff/Child Ratios

Violation: Group size requirements were not met as evidenced by 13 children, ages 6 months to 2-years-old on the play yard, were cared for by 4 adult caregiver(s).

Rule Reference: 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.

Correction Required: Staff/child ratios and group sizes shall be maintained at all times.

Correction Verification: Return Inspection

Compliance Date: 4/7/2026

5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers

Violation: Hazardous items as follows were accessible to children: cleaning supplies in a tote and a mop bucket with water. The item(s) was/were located on the floor in the staff bathroom. This bathroom door is not locked giving the children access, no child was observed unsupervised near this door during this inspection.

Rule Reference: 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.

Correction Required: Hazardous items shall be inaccessible to children.

Correction Verification: Corrected on Site

Compliance Date: 3/24/2026

5 CSR 25-500.112 Staff/Child Ratios

Violation: Group size requirements were not met as evidenced by 13 children, ages 6 months to 2-years-old on the play yard, were cared for by 4 adult caregiver(s).

Rule Reference: 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.

Correction Required: Staff/child ratios and group sizes shall be maintained at all times.

Correction Verification: Return Inspection

5 CSR 25-500.222 Records and Reports

Violation: 1 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.

Rule Reference: 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;

Correction Required: Child enrollment information shall be completed and on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.222 Records and Reports

Violation: 2 child(ren) records did not include work telephone number of parent(s), guardian or legal custodian.

Rule Reference: 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;

Correction Required: Child enrollment information shall be completed and on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.222 Records and Reports

Violation: 2 child(ren) records did not include work schedule of parent(s), guardian or legal custodian.

Rule Reference: 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;

Correction Required: Child enrollment information shall be completed and on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.222 Records and Reports

Violation: 2 child(ren) records did not include employers' address of parent(s), guardian or legal custodian.

Rule Reference: 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;

Correction Required: Child enrollment information shall be completed and on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.222 Records and Reports

Violation: 1 child(ren) records did not include employers' name of parent(s), guardian or legal custodian.

Rule Reference: 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;

Correction Required: Child enrollment information shall be completed and on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.122 Medical Examination Reports

Violation: The medical examination report on file for Hailey Kamberaj was older than 12 months before the individual's begin date at the facility.

Rule Reference: 5 CSR 25-500.122 Medical Examination Reports (1) (C) states: Medical examination reports shall be completed not more than twelve (12) months prior to beginning work in the facility and may be transferable to another child care facility for subsequent employment.

Correction Required: Medical reports shall be on file as required.

Correction Verification: Submit Documentation

Compliance Date: 3/19/2026

5 CSR 25-500.122 Medical Examination Reports

Violation: A medical examination report included either a Risk Assessment for Tuberculosis form or a negative tuberculin skin test (TST) which was completed more than 12 months before beginning work in the facility for the following staff: Hailey Kamberaj.

Rule Reference: 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.

Correction Required: Medical examination reports shall include Risk Assessment for Tuberculosis forms or negative tuberculin skin test (TST) as required.

Correction Verification: Submit Documentation

Compliance Date: 3/19/2026

5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers

Violation: Diapering requirements were not met as evidenced by the diapering table was not located where caregiver could maintain supervision of his/her group of children. The diapering table was located in the middle of the west wall, of the infant classroom which made the area on the other side of the refrigerator a blind spot. This was a new full size refrigerator. This was corrected during the inspection.

Rule Reference: 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.

Correction Required: The facility shall provide a safe and clean diapering table as required.

Correction Verification: Corrected on Site

Compliance Date: 3/13/2026

5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers

Violation: Diapering requirements were not met as evidenced by the diapering table was not located where caregiver could maintain supervision of his/her group of children. The diapering table was located in the closet on the west wall of the toddler room, the diapering table had been pushed back too far in the closet making part of the room a blind spot.

Rule Reference: 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.

Correction Required: The facility shall provide a safe and clean diapering table as required.

Correction Verification: Corrected on Site

Compliance Date: 3/13/2026

5 CSR 25-500.092 Furniture, Equipment and Materials

Violation: Outdoor equipment, trike, in play yard was not in good condition as evidenced by missing handle bar covers.

Rule Reference: 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.

Correction Required: Outdoor play equipment shall be safe and in good repair.

Correction Verification: Corrected on Site

Compliance Date: 3/13/2026

5 CSR 25-500.122 Medical Examination Reports

Violation: The medical examination report on file for Hailey Kamberaj was older than 12 months before the individual's begin date at the facility.

Rule Reference: 5 CSR 25-500.122 Medical Examination Reports (1) (C) states: Medical examination reports shall be completed not more than twelve (12) months prior to beginning work in the facility and may be transferable to another child care facility for subsequent employment.

Correction Required: Medical reports shall be on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.122 Medical Examination Reports

Violation: A medical examination report included either a Risk Assessment for Tuberculosis form or a negative tuberculin skin test (TST) which was completed more than 12 months before beginning work in the facility for the following staff: Hailey Kamberaj.

Rule Reference: 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.

Correction Required: Medical examination reports shall include Risk Assessment for Tuberculosis forms or negative tuberculin skin test (TST) as required.

Correction Verification: Submit Documentation

5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers

Violation: Diapering requirements were not met as evidenced by the diapering table was not located where caregiver could maintain supervision of his/her group of children. The diapering table was located next to the sink, with the staff's back to part of the room. This was during nap time and the diaper change table could not be moved back in the position it was agreed upon during the initial inspection would allow for full view of the classroom during diapering.

Rule Reference: 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.

Correction Required: The facility shall provide a safe and clean diapering table as required.

Correction Verification: Submit Documentation

Compliance Date: 9/18/2025

5 CSR 25-500.092 Furniture, Equipment and Materials

Violation: Sleeping equipment was not arranged to provide required spacing as evidenced by the aisle on the long side of the napping equipment was too narrow - the space measured less 24 inches.

Rule Reference: 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.

Correction Required: Caregivers shall provide a two foot (2') aisle on one long side of the napping equipment.

Correction Verification: Submit Documentation

Compliance Date: 9/18/2025

5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers

Violation: Diapering requirements were not met as evidenced by the diapering table was not located where caregiver could maintain supervision of his/her group of children. The diapering table was located next to the sink, with the staff's back to part of the room. This was during nap time and the diaper change table could not be moved back in the position it was agreed upon during the initial inspection would allow for full view of the classroom during diapering.

Rule Reference: 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.

Correction Required: The facility shall provide a safe and clean diapering table as required.

Correction Verification: Submit Documentation

5 CSR 25-500.092 Furniture, Equipment and Materials

Violation: Sleeping equipment was not arranged to provide required spacing as evidenced by the aisle on the long side of the napping equipment was too narrow - the space measured less 24 inches.

Rule Reference: 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.

Correction Required: Caregivers shall provide a two foot (2') aisle on one long side of the napping equipment.

Correction Verification: Submit Documentation

5 CSR 25-500.092 Furniture, Equipment and Materials

Violation: Outdoor equipment, teetertotter , in play yard was not in good condition as evidenced by padding on one seat exposed, padding on one seat back was gone, along with the cover exposing the hard plastic seat back, the covering on the other seat and seat back is torn..

Rule Reference: 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.

Correction Required: Outdoor play equipment shall be safe and in good repair.

Correction Verification: Submit Documentation

Compliance Date: 9/5/2025

5 CSR 25-500.112 Staff/Child Ratios

Violation: Staff/child ratio requirements were not met as evidenced by 1 children , ages 6-year-old, were cared for by 0 adult caregiver(s).

Rule Reference: 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.

Correction Required: Staff/child ratios and group sizes shall be maintained at all times.

Correction Verification: Return Inspection

Compliance Date: 9/17/2025

5 CSR 25-500.122 Medical Examination Reports

Violation: Medical examination report(s) was/were not on file for Alayna Giver and Kaia Miller as evidenced by a medical examination was not on file within 30 days of an individual beginning to work with children.

Rule Reference: 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.

Correction Required: Medical reports shall be on file as required.

Correction Verification: Submit Documentation

Compliance Date: 9/5/2025

5 CSR 25-500.122 Medical Examination Reports

Violation: 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: Kaia Miller and Haylee Prest.

Rule Reference: 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.

Correction Required: Medical examination reports shall include Risk Assessment for Tuberculosis forms or negative tuberculin skin test (TST) as required.

Correction Verification: Submit Documentation

Compliance Date: 9/5/2025

5 CSR 25-500.182 Child Care Program

Violation: Requirements for supervision of napping or sleeping children were not met as evidenced by the caregiver was present with napping children but was unable to see and hear all children.

Rule Reference: 5 CSR 25-500.182 Child Care Program (1) (A) 5. states: A caregiver shall remain in the room with preschool and school-age children while they are napping or sleeping and shall be able to see and hear them if they have difficulty during napping or when they awaken.

Correction Required: A caregiver shall be in the room with napping children, and shall be able to see and hear them.

Correction Verification: Return Inspection

Compliance Date: 9/17/2025

5 CSR 25-500.192 Health Care

Violation: Caregiver did not remain in close proximity to an ill child as evidenced by a 6-year-old child was observed alone in the director's office, this child was identified as the director's grandson, who was out of school due to illness, the child's mother and grandmother were giving other staff breaks, unknow how long the child was in the office alone.

Rule Reference: 5 CSR 25-500.192 Health Care (2) (H) states: The caregiver shall be in close proximity to the child until the parent(s) arrives. Close proximity means that a caregiver is close enough to hear any sounds a child might make that would indicate a need for assistance.

Correction Required: A caregiver shall remain close to an isolated ill child.

Correction Verification: Return Inspection

Compliance Date: 9/17/2025

5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers

Violation: Diapering requirements were not met as evidenced by the diapering table was not located where caregiver could maintain supervision of his/her group of children. The diapering table was located too far back in the alcove area in the toddler area.

Rule Reference: 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.

Correction Required: The facility shall provide a safe and clean diapering table as required.

Correction Verification: Corrected on Site

Compliance Date: 9/3/2025

5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers

Violation: Diapering requirements were not met as evidenced by the diapering table was not located where caregiver could maintain supervision of his/her group of children. The diapering table was located next to the sink, with the staff's back to part of the room. This was during nap time and the diaper change table could not be moved back in the position it was agreed upon during the initial inspection would allow for full view of the classroom during diapering.

Rule Reference: 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.

Correction Required: The facility shall provide a safe and clean diapering table as required.

Correction Verification: Submit Documentation

5 CSR 25-500.092 Furniture, Equipment and Materials

Violation: Outdoor equipment, teetertotter , in play yard was not in good condition as evidenced by padding on one seat exposed, padding on one seat back was gone, along with the cover exposing the hard plastic seat back, the covering on the other seat and seat back is torn..

Rule Reference: 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.

Correction Required: Outdoor play equipment shall be safe and in good repair.

Correction Verification: Submit Documentation

5 CSR 25-500.112 Staff/Child Ratios

Violation: Staff/child ratio requirements were not met as evidenced by 1 children , ages 6-year-old, were cared for by 0 adult caregiver(s).

Rule Reference: 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.

Correction Required: Staff/child ratios and group sizes shall be maintained at all times.

Correction Verification: Return Inspection

5 CSR 25-500.122 Medical Examination Reports

Violation: Medical examination report(s) was/were not on file for Alayna Giver and Kaia Miller as evidenced by a medical examination was not on file within 30 days of an individual beginning to work with children.

Rule Reference: 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.

Correction Required: Medical reports shall be on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.122 Medical Examination Reports

Violation: 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: Kaia Miller and Haylee Prest.

Rule Reference: 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.

Correction Required: Medical examination reports shall include Risk Assessment for Tuberculosis forms or negative tuberculin skin test (TST) as required.

Correction Verification: Submit Documentation

5 CSR 25-500.182 Child Care Program

Violation: Requirements for supervision of napping or sleeping children were not met as evidenced by the caregiver was present with napping children but was unable to see and hear all children.

Rule Reference: 5 CSR 25-500.182 Child Care Program (1) (A) 5. states: A caregiver shall remain in the room with preschool and school-age children while they are napping or sleeping and shall be able to see and hear them if they have difficulty during napping or when they awaken.

Correction Required: A caregiver shall be in the room with napping children, and shall be able to see and hear them.

Correction Verification: Return Inspection

5 CSR 25-500.192 Health Care

Violation: Caregiver did not remain in close proximity to an ill child as evidenced by a 6-year-old child was observed alone in the director's office, this child was identified as the director's grandson, who was out of school due to illness, the child's mother and grandmother were giving other staff breaks, unknow how long the child was in the office alone.

Rule Reference: 5 CSR 25-500.192 Health Care (2) (H) states: The caregiver shall be in close proximity to the child until the parent(s) arrives. Close proximity means that a caregiver is close enough to hear any sounds a child might make that would indicate a need for assistance.

Correction Required: A caregiver shall remain close to an isolated ill child.

Correction Verification: Return Inspection

5 CSR 25-600.020 General Requirements

Violation: Criminal background check results were not on file for Alisabeth Lanois and Daesha Shull .

Rule Reference: 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.

Correction Required: Required results of criminal background checks shall be on file.

Correction Verification: Corrected on Site

Compliance Date: 9/3/2025

5 CSR 25-500.092 Furniture, Equipment and Materials

Violation: Soft objects, loose bedding or any object that can increase risk of entrapment, suffocation or strangulation was observed as evidenced by a 10-month-old was observed in a crib with a blanket.

Rule Reference: 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.

Correction Required: Infant napping equipment shall be free of soft objects, loose bedding or any object that can increase the risk of entrapment, suffocation or strangulation.

Correction Verification: Return Inspection

Compliance Date: 8/1/2025

5 CSR 25-500.092 Furniture, Equipment and Materials

Violation: Soft objects, loose bedding or any object that can increase risk of entrapment, suffocation or strangulation was observed as evidenced by a 10-month-old was observed in a crib with a blanket.

Rule Reference: 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.

Correction Required: Infant napping equipment shall be free of soft objects, loose bedding or any object that can increase the risk of entrapment, suffocation or strangulation.

Correction Verification: Corrected on Site

Compliance Date: 7/18/2025

5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers

Violation: The premises were not safe and suitable as evidenced by the gate on the play yard is locked with a pad lock, there is no key located on the play yard.

Rule Reference: 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.

Correction Required: The premises shall be safe and suitable for the care of children.

Correction Verification: Submit Documentation

Compliance Date: 3/14/2025

5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers

Violation: The infant/toddler space had partition(s) that were not 4' tall - the height of the partition(s) were where there should have been a 4' gate or door it was open, not totally separating the 2 groups of children”. this is the best option. They had build a stable partition wall, but left the end open, she seems surprised that a ½ door or gate 4’ tall was also need to keep the 2 groups physically separated.

Rule Reference: 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (2) (B) 2. B. (V) states: In facilities initially licensed for infant/toddler care after the effective date of these rules or facilities adding new infant/toddler space, no more than twenty four (24) infants/toddlers and/or two (2)-year olds shall be in a room. A room shall be defined as an area separated from other parts of the building by floor-to-ceiling walls. Stable partitions a minimum of four feet (4') in height shall be used to separate the infant/toddler or two (2)-year old groups, or both, in a room;

Correction Required: The infant/toddler space shall be separated by floor-to-ceiling walls, have stable partitions, and care for no more than 24 children at one time.

Correction Verification: Submit Documentation

Compliance Date: 3/18/2025

5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers

Violation: The walls located in the Sensory Room was/were not in good condition as evidenced by hole in wall where an electronic devise had been removed.

Rule Reference: 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.

Correction Required: Walls, ceilings, and floors shall be made of approved materials, easily cleaned and in good condition.

Correction Verification: Submit Documentation

Compliance Date: 3/14/2025

5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers

Violation: Doors to the bathroom or stalls did not meet requirements as evidenced by there was a lock on the bathroom door.

Rule Reference: 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (3) (A) 5. states: Locks or latches shall not be used on bathroom or bathroom stall doors used by children below the first grade.

Correction Required: Doors to bathrooms or stalls, used by children below the first grade, shall not have locks or latches.

Correction Verification: Submit Documentation

Compliance Date: 3/14/2025

5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers

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

Rule Reference: 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.

Correction Required: The facility shall provide a safe and clean diapering table as required.

Correction Verification: Submit Documentation

Compliance Date: 3/18/2025

5 CSR 25-500.087 Fire Safety

Violation: Requirements of 19 CSR 30-62.087 Fire Safety were not met as evidenced by the disaster and tornado drill record was not available on the premises.

Rule Reference: 5 CSR 25-500.087 Fire Safety (2) (F) states: Child care staff shall conduct at least one (1) fire drill each month and a disaster drill at least every three (3) months. The disaster drills shall include tornado drills. The provider shall maintain a written record at the facility of the date, type of drill, time required to evacuate the building, and number of children present during the drill.

Correction Required: Fire, tornado, and other disaster drills shall be completed and recorded as required.

Correction Verification: Submit Documentation

Compliance Date: 11/18/2024

5 CSR 25-500.087 Fire Safety

Violation: Requirements of 19 CSR 30-62.087 Fire Safety were not met as evidenced by the fire drill record was not available on the premises.

Rule Reference: 5 CSR 25-500.087 Fire Safety (2) (F) states: Child care staff shall conduct at least one (1) fire drill each month and a disaster drill at least every three (3) months. The disaster drills shall include tornado drills. The provider shall maintain a written record at the facility of the date, type of drill, time required to evacuate the building, and number of children present during the drill.

Correction Required: Fire, tornado, and other disaster drills shall be completed and recorded as required.

Correction Verification: Submit Documentation

Compliance Date: 11/18/2024

5 CSR 25-500.087 Fire Safety

Violation: Requirements of 19 CSR 30-62.087 Fire Safety were not met as evidenced by the disaster and tornado drill was not held at least one time every three months.

Rule Reference: 5 CSR 25-500.087 Fire Safety (2) (F) states: Child care staff shall conduct at least one (1) fire drill each month and a disaster drill at least every three (3) months. The disaster drills shall include tornado drills. The provider shall maintain a written record at the facility of the date, type of drill, time required to evacuate the building, and number of children present during the drill.

Correction Required: Fire, tornado, and other disaster drills shall be completed and recorded as required.

Correction Verification: Submit Documentation

Compliance Date: 11/18/2024

5 CSR 25-500.087 Fire Safety

Violation: Requirements of 19 CSR 30-62.087 Fire Safety were not met as evidenced by the disaster and tornado drill record was not available on the premises.

Rule Reference: 5 CSR 25-500.087 Fire Safety (2) (F) states: Child care staff shall conduct at least one (1) fire drill each month and a disaster drill at least every three (3) months. The disaster drills shall include tornado drills. The provider shall maintain a written record at the facility of the date, type of drill, time required to evacuate the building, and number of children present during the drill.

Correction Required: Fire, tornado, and other disaster drills shall be completed and recorded as required.

Correction Verification: Submit Documentation

5 CSR 25-500.087 Fire Safety

Violation: Requirements of 19 CSR 30-62.087 Fire Safety were not met as evidenced by the fire drill record was not available on the premises.

Rule Reference: 5 CSR 25-500.087 Fire Safety (2) (F) states: Child care staff shall conduct at least one (1) fire drill each month and a disaster drill at least every three (3) months. The disaster drills shall include tornado drills. The provider shall maintain a written record at the facility of the date, type of drill, time required to evacuate the building, and number of children present during the drill.

Correction Required: Fire, tornado, and other disaster drills shall be completed and recorded as required.

Correction Verification: Submit Documentation

5 CSR 25-500.087 Fire Safety

Violation: Requirements of 19 CSR 30-62.087 Fire Safety were not met as evidenced by the disaster and tornado drill was not held at least one time every three months.

Rule Reference: 5 CSR 25-500.087 Fire Safety (2) (F) states: Child care staff shall conduct at least one (1) fire drill each month and a disaster drill at least every three (3) months. The disaster drills shall include tornado drills. The provider shall maintain a written record at the facility of the date, type of drill, time required to evacuate the building, and number of children present during the drill.

Correction Required: Fire, tornado, and other disaster drills shall be completed and recorded as required.

Correction Verification: Submit Documentation

5 CSR 25-500.042 Licensing Process

Violation: The ages of children was/were exceeded as evidenced by (7-12-24) one child age 23 months has been enrolled at the facility since 4/22/24 when the child was 21 months of age.

Rule Reference: 5 CSR 25-500.042 Licensing Process (18) states: The number and ages of children a group child care home or child care center is authorized to have in care at any one time shall be specified on the license and shall not be exceeded except as permitted within these rules.

Correction Required: The facility shall maintain compliance with the specifications on the license.

Correction Verification: Return Inspection

Compliance Date: 7/30/2024

5 CSR 25-500.042 Licensing Process

Violation: The ages of children was/were exceeded as evidenced by (6-27-24) one child age 23 months has been enrolled at the facility since 4/22/24 when the child was 21 months of age.

Rule Reference: 5 CSR 25-500.042 Licensing Process (18) states: The number and ages of children a group child care home or child care center is authorized to have in care at any one time shall be specified on the license and shall not be exceeded except as permitted within these rules.

Correction Required: The facility shall maintain compliance with the specifications on the license.

Correction Verification: Return Inspection

Compliance Date: 7/30/2024

5 CSR 25-500.112 Staff/Child Ratios

Violation: Staff/child ratio requirements were not met as evidenced by (7-12-23) 6 children , ages 23 months to 2-years-old, were cared for by 1 adult caregiver(s).

Rule Reference: 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.

Correction Required: Staff/child ratios and group sizes shall be maintained at all times.

Correction Verification: Return Inspection

Compliance Date: 7/30/2024

5 CSR 25-500.112 Staff/Child Ratios

Violation: Staff/child ratio requirements were not met as evidenced by ( 6-27-24) 7 children , ages 23 months to 2-years-old., were cared for by 1 adult caregiver(s).

Rule Reference: 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.

Correction Required: Staff/child ratios and group sizes shall be maintained at all times.

Correction Verification: Return Inspection

Compliance Date: 7/30/2024

5 CSR 25-500.122 Medical Examination Reports

Violation: Medical examination report(s) was/were not on file for Alexa Baird as evidenced by a medical examination was not on file within 30 days of an individual beginning to work with children.

Rule Reference: 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.

Correction Required: Medical reports shall be on file as required.

Correction Verification: Submit Documentation

Compliance Date: 7/19/2024

5 CSR 25-500.122 Medical Examination Reports

Violation: 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: Alexa Baird.

Rule Reference: 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.

Correction Required: Medical examination reports shall include Risk Assessment for Tuberculosis forms or negative tuberculin skin test (TST) as required.

Correction Verification: Submit Documentation

Compliance Date: 7/19/2024

5 CSR 25-500.122 Medical Examination Reports

Violation: 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 4/22/24.

Rule Reference: 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.

Correction Required: Child medical requirements shall be completed and on file as required.

Correction Verification: Submit Documentation

Compliance Date: 7/18/2024

5 CSR 25-500.132 Admission Policies and Procedures

Violation: A child younger than 2 years of age was observed in care and the facility is not licensed for I/T care.

Rule Reference: 5 CSR 25-500.132 Admission Policies and Procedures (4) states: Only children two (2) years of age and older shall be accepted for care unless the facility has been specifically licensed to include infant/toddler care

Correction Required: The facility shall not care for children under 2 years old.

Correction Verification: Submit Documentation

Compliance Date: 7/30/2024

5 CSR 25-500.132 Admission Policies and Procedures

Violation: The facility did not meet requirements for child enrollment and health information as evidenced by this page of the enrollment form was missing.

Rule Reference: 5 CSR 25-500.132 Admission Policies and Procedures (8) (E) 4. states: Instructions for action to be taken if the parent(s) or physician designated by the parent(s) cannot be reached in an emergency and permission for emergency medical care;

Correction Required: Child enrollment information shall be completed and on file as required.

Correction Verification: Submit Documentation

Compliance Date: 7/18/2024

5 CSR 25-500.132 Admission Policies and Procedures

Violation: Written permission was not on file for other transportation.

Rule Reference: 5 CSR 25-500.132 Admission Policies and Procedures (8) (E) 6. states: Permission for field trips, transportation to and from school and other transportation;

Correction Required: Written permission for field and transportation shall be on file as required.

Correction Verification: Submit Documentation

Compliance Date: 7/18/2024

5 CSR 25-500.132 Admission Policies and Procedures

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

Rule Reference: 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;

Correction Required: Child enrollment information shall be completed and on file as required.

Correction Verification: Submit Documentation

Compliance Date: 7/18/2024

5 CSR 25-500.132 Admission Policies and Procedures

Violation: 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.

Rule Reference: 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;

Correction Required: Child enrollment information shall be completed and on file as required.

Correction Verification: Submit Documentation

Compliance Date: 7/18/2024

5 CSR 25-500.132 Admission Policies and Procedures

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

Rule Reference: 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;

Correction Required: Child enrollment information shall be completed and on file as required.

Correction Verification: Submit Documentation

Compliance Date: 7/18/2024

5 CSR 25-500.132 Admission Policies and Procedures

Violation: 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.

Rule Reference: 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.

Correction Required: Child enrollment information shall be completed and on file as required.

Correction Verification: Submit Documentation

Compliance Date: 7/18/2024

5 CSR 25-500.132 Admission Policies and Procedures

Violation: The facility did not meet requirements for child enrollment and health information on file as evidenced by 1 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.

Rule Reference: 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

Correction Required: Child enrollment information shall be completed and on file as requested.

Correction Verification: Submit Documentation

Compliance Date: 7/18/2024

5 CSR 25-500.042 Licensing Process

Violation: The ages of children was/were exceeded as evidenced by (6-27-24) one child age 23 months has been enrolled at the facility since 4/22/24 when the child was 21 months of age.

Rule Reference: 5 CSR 25-500.042 Licensing Process (18) states: The number and ages of children a group child care home or child care center is authorized to have in care at any one time shall be specified on the license and shall not be exceeded except as permitted within these rules.

Correction Required: The facility shall maintain compliance with the specifications on the license.

Correction Verification: Return Inspection

5 CSR 25-500.042 Licensing Process

Violation: The ages of children was/were exceeded as evidenced by (7-12-24) one child age 23 months has been enrolled at the facility since 4/22/24 when the child was 21 months of age.

Rule Reference: 5 CSR 25-500.042 Licensing Process (18) states: The number and ages of children a group child care home or child care center is authorized to have in care at any one time shall be specified on the license and shall not be exceeded except as permitted within these rules.

Correction Required: The facility shall maintain compliance with the specifications on the license.

Correction Verification: Return Inspection

5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers

Violation: The walls located bathroom was/were not in good condition as evidenced by hole in drywall where toilet paper holder had been torn off the wall.

Rule Reference: 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.

Correction Required: Walls, ceilings, and floors shall be made of approved materials, easily cleaned and in good condition.

Correction Verification: Submit Documentation

Compliance Date: 7/3/2024

5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers

Violation: Bathroom supplies were not available and accessible to children as evidenced by there were no paper towels.

Rule Reference: 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (3) (A) 4. states: Paper towels, soap and toilet paper shall be provided and easily accessible so the children can reach them without assistance.

Correction Required: The facility shall provide paper towels, soap and toilet paper, accessible for children's use.

Correction Verification: Submit Documentation

Compliance Date: 7/3/2024

5 CSR 25-500.112 Staff/Child Ratios

Violation: Staff/child ratio requirements were not met as evidenced by ( 6-27-24) 7 children , ages 23 months to 2-years-old., were cared for by 1 adult caregiver(s).

Rule Reference: 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.

Correction Required: Staff/child ratios and group sizes shall be maintained at all times.

Correction Verification: Return Inspection

5 CSR 25-500.112 Staff/Child Ratios

Violation: Staff/child ratio requirements were not met as evidenced by (7-12-23) 6 children , ages 23 months to 2-years-old, were cared for by 1 adult caregiver(s).

Rule Reference: 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.

Correction Required: Staff/child ratios and group sizes shall be maintained at all times.

Correction Verification: Return Inspection

5 CSR 25-500.122 Medical Examination Reports

Violation: Medical examination report(s) was/were not on file for Alexa Baird as evidenced by a medical examination was not on file within 30 days of an individual beginning to work with children.

Rule Reference: 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.

Correction Required: Medical reports shall be on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.122 Medical Examination Reports

Violation: 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: Alexa Baird.

Rule Reference: 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.

Correction Required: Medical examination reports shall include Risk Assessment for Tuberculosis forms or negative tuberculin skin test (TST) as required.

Correction Verification: Submit Documentation

5 CSR 25-500.122 Medical Examination Reports

Violation: 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 4/22/24.

Rule Reference: 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.

Correction Required: Child medical requirements shall be completed and on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.132 Admission Policies and Procedures

Violation: A child younger than 2 years of age was observed in care and the facility is not licensed for I/T care.

Rule Reference: 5 CSR 25-500.132 Admission Policies and Procedures (4) states: Only children two (2) years of age and older shall be accepted for care unless the facility has been specifically licensed to include infant/toddler care

Correction Required: The facility shall not care for children under 2 years old.

Correction Verification: Submit Documentation

5 CSR 25-500.132 Admission Policies and Procedures

Violation: The facility did not meet requirements for child enrollment and health information as evidenced by this page of the enrollment form was missing.

Rule Reference: 5 CSR 25-500.132 Admission Policies and Procedures (8) (E) 4. states: Instructions for action to be taken if the parent(s) or physician designated by the parent(s) cannot be reached in an emergency and permission for emergency medical care;

Correction Required: Child enrollment information shall be completed and on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.132 Admission Policies and Procedures

Violation: Written permission was not on file for other transportation.

Rule Reference: 5 CSR 25-500.132 Admission Policies and Procedures (8) (E) 6. states: Permission for field trips, transportation to and from school and other transportation;

Correction Required: Written permission for field and transportation shall be on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.132 Admission Policies and Procedures

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

Rule Reference: 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;

Correction Required: Child enrollment information shall be completed and on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.132 Admission Policies and Procedures

Violation: 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.

Rule Reference: 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;

Correction Required: Child enrollment information shall be completed and on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.132 Admission Policies and Procedures

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

Rule Reference: 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;

Correction Required: Child enrollment information shall be completed and on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.132 Admission Policies and Procedures

Violation: 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.

Rule Reference: 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.

Correction Required: Child enrollment information shall be completed and on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.132 Admission Policies and Procedures

Violation: The facility did not meet requirements for child enrollment and health information on file as evidenced by 1 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.

Rule Reference: 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

Correction Required: Child enrollment information shall be completed and on file as requested.

Correction Verification: Submit Documentation

5 CSR 25-500.042 Licensing Process

Violation: The ages of children was/were exceeded as evidenced by one child age 23 months has been enrolled at the facility since 4/22/24 when the child was 21 months of age.

Rule Reference: 5 CSR 25-500.042 Licensing Process (18) states: The number and ages of children a group child care home or child care center is authorized to have in care at any one time shall be specified on the license and shall not be exceeded except as permitted within these rules.

Correction Required: The facility shall maintain compliance with the specifications on the license.

Correction Verification: Return Inspection

5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers

Violation: The walls located bathroom was/were not in good condition as evidenced by hole in drywall where toilet paper holder had been torn off the wall.

Rule Reference: 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.

Correction Required: Walls, ceilings, and floors shall be made of approved materials, easily cleaned and in good condition.

Correction Verification: Submit Documentation

5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers

Violation: Bathroom supplies were not available and accessible to children as evidenced by there were no paper towels.

Rule Reference: 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (3) (A) 4. states: Paper towels, soap and toilet paper shall be provided and easily accessible so the children can reach them without assistance.

Correction Required: The facility shall provide paper towels, soap and toilet paper, accessible for children's use.

Correction Verification: Submit Documentation

5 CSR 25-500.112 Staff/Child Ratios

Violation: Staff/child ratio requirements were not met as evidenced by 7 children , ages 23 months to 2-years-old., were cared for by 1 adult caregiver(s).

Rule Reference: 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.

Correction Required: Staff/child ratios and group sizes shall be maintained at all times.

Correction Verification: Return Inspection

5 CSR 25-500.122 Medical Examination Reports

Violation: Medical examination report(s) was/were not on file for Alexa Baird as evidenced by a medical examination was not on file within 30 days of an individual beginning to work with children.

Rule Reference: 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.

Correction Required: Medical reports shall be on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.122 Medical Examination Reports

Violation: 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: Alexa Baird.

Rule Reference: 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.

Correction Required: Medical examination reports shall include Risk Assessment for Tuberculosis forms or negative tuberculin skin test (TST) as required.

Correction Verification: Submit Documentation

5 CSR 25-500.122 Medical Examination Reports

Violation: 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 4/22/24.

Rule Reference: 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.

Correction Required: Child medical requirements shall be completed and on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.132 Admission Policies and Procedures

Violation: A child younger than 2 years of age was observed in care and the facility is not licensed for I/T care.

Rule Reference: 5 CSR 25-500.132 Admission Policies and Procedures (4) states: Only children two (2) years of age and older shall be accepted for care unless the facility has been specifically licensed to include infant/toddler care

Correction Required: The facility shall not care for children under 2 years old.

Correction Verification: Submit Documentation

5 CSR 25-500.132 Admission Policies and Procedures

Violation: The facility did not meet requirements for child enrollment and health information as evidenced by this page of the enrollment form was missing.

Rule Reference: 5 CSR 25-500.132 Admission Policies and Procedures (8) (E) 4. states: Instructions for action to be taken if the parent(s) or physician designated by the parent(s) cannot be reached in an emergency and permission for emergency medical care;

Correction Required: Child enrollment information shall be completed and on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.132 Admission Policies and Procedures

Violation: Written permission was not on file for other transportation.

Rule Reference: 5 CSR 25-500.132 Admission Policies and Procedures (8) (E) 6. states: Permission for field trips, transportation to and from school and other transportation;

Correction Required: Written permission for field and transportation shall be on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.132 Admission Policies and Procedures

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

Rule Reference: 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;

Correction Required: Child enrollment information shall be completed and on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.132 Admission Policies and Procedures

Violation: 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.

Rule Reference: 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;

Correction Required: Child enrollment information shall be completed and on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.132 Admission Policies and Procedures

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

Rule Reference: 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;

Correction Required: Child enrollment information shall be completed and on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.132 Admission Policies and Procedures

Violation: 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.

Rule Reference: 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.

Correction Required: Child enrollment information shall be completed and on file as required.

Correction Verification: Submit Documentation

5 CSR 25-500.132 Admission Policies and Procedures

Violation: The facility did not meet requirements for child enrollment and health information on file as evidenced by 1 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.

Rule Reference: 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

Correction Required: Child enrollment information shall be completed and on file as requested.

Correction Verification: Submit Documentation

5 CSR 25-500.222 Records and Reports

Violation: 1 child(ren) records did not include telephone number of family physician or hospital.

Rule Reference: 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;

Correction Required: Child enrollment information shall be completed and on file as required.

Correction Verification: Corrected on Site

Compliance Date: 6/27/2024

5 CSR 25-500.222 Records and Reports

Violation: 1 child(ren) records did not include name of family physician or hospital.

Rule Reference: 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;

Correction Required: Child enrollment information shall be completed and on file as required.

Correction Verification: Corrected on Site

Compliance Date: 6/27/2024