Little Learners Spectrum Center, Inc.

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 a camera cord in Infant 2 and a camera cord in Infant 3 were not secure.

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: Corrected on Site

Compliance Date: 8/13/2026

5 CSR 25-500.092 Furniture, Equipment and Materials

Violation: Requirements for feeding equipment for infants and toddlers who are unable to sit at a table were not met as evidenced by no restraints are used.

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

Correction Required: Safe and secure feeding equipment shall be provided as required.

Correction Verification: Corrected on Site

Compliance Date: 8/13/2026

5 CSR 25-500.092 Furniture, Equipment and Materials

Violation: Stationary equipment, swing set, was unsafe as evidenced by the equipment was not securely anchored.

Rule Reference: 5 CSR 25-500.092 Furniture, Equipment and Materials (3) (D) states: Stationary equipment such as swings, slides and climbers shall be securely anchored, have no exposed footings and be placed to avoid accidents or collisions.

Correction Required: Stationary equipment shall be safely installed, stable and securely anchored.

Correction Verification: Corrected on Site

Compliance Date: 8/13/2026

5 CSR 25-500.192 Health Care

Violation: Facility did not submit the 2025 annual summary report showing immunization status of each child enrolled by January 15.

Rule Reference: 5 CSR 25-500.192 Health Care (4) (D) states: The administrator of each day care facility shall prepare a record of immunization of each child enrolled in or attending the facility. An annual summary report shall be made by January 15 showing the immunization status of each child enrolled, using forms provided by the department (see 19 CSR 40-61.185). The immunization records shall be available for review by department personnel upon request.

Correction Required: Facility shall submit an annual summary report by January 15 showing the immunization status of each child enrolled.

Correction Verification: Submit Documentation

5 CSR 25-500.102 Personnel

Violation: Madison Williams did not complete safe sleep training within 30 days of employment or volunteering at the facility.

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

Correction Required: The department-approved safe sleep training must be completed within 30 days of employment or volunteering.

Correction Verification: Return Inspection

Compliance Date: 3/9/2026

5 CSR 25-500.052 Annual Requirements

Violation: The annual sanitation inspection was not conducted.

Rule Reference: 5 CSR 25-500.052 Annual Requirements (2) (B) states: Evidence of compliance with local, state, or both, sanitation requirements.

Correction Required: The facility shall submit evidence of compliance with annual sanitation requirements.

Correction Verification: Return Inspection

Compliance Date: 3/3/2026

5 CSR 25-500.102 Personnel

Violation: Madison Williams did not complete safe sleep training within 30 days of employment or volunteering at the facility.

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

Correction Required: The department-approved safe sleep training must be completed within 30 days of employment or volunteering.

Correction Verification: Return Inspection

5 CSR 25-500.122 Medical Examination Reports

Violation: Medical examination report(s) was/were not on file for Madison Williams 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: Return Inspection

Compliance Date: 3/5/2026

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: Madison Williams.

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: Return Inspection

Compliance Date: 3/5/2026

5 CSR 25-500.052 Annual Requirements

Violation: The annual sanitation inspection was not conducted.

Rule Reference: 5 CSR 25-500.052 Annual Requirements (2) (B) states: Evidence of compliance with local, state, or both, sanitation requirements.

Correction Required: The facility shall submit evidence of compliance with annual sanitation requirements.

Correction Verification: Return Inspection

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

Violation: The requirements for protective outlet covers or twist-lock outlets were not met as evidenced by electrical outlets were not covered in that one outlet was missing a protective outlet cover in the Therapy Room.

Rule Reference: 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (G) states: Protective outlet covers or twist-lock outlets shall be used in areas accessible to the children.

Correction Required: The facility shall use outlet covers or twist-lock outlets as required.

Correction Verification: Corrected on Site

Compliance Date: 2/24/2026

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: diaper rash spray and diaper cream. The item(s) was/were located in cubbies located outside of the restroom.

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: 2/24/2026

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: diaper cream and antibiotic cream. The item(s) was/were located in the upstairs restroom.

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: 2/24/2026

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: pain reliever. The item(s) was/were located on an office shelf.

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: 2/24/2026

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 one TV cord located in the upstairs area was not secure.

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: Corrected on Site

Compliance Date: 2/24/2026

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

Violation: The requirements for protective outlet covers or twist-lock outlets were not met as evidenced by electrical outlets were not covered in that four outlets were missing protective outlet covers in the School-Age Room.

Rule Reference: 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (G) states: Protective outlet covers or twist-lock outlets shall be used in areas accessible to the children.

Correction Required: The facility shall use outlet covers or twist-lock outlets as required.

Correction Verification: Corrected on Site

Compliance Date: 2/24/2026

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: diaper cream, sunscreen and Walmart bags. The item(s) was/were located under the diaper table in the Infant/Toddler Unit.

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: 2/24/2026

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

Violation: The floors located in the cubby area of the Preschool Room/Gym was/were not in good condition as evidenced by the threshold was missing.

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: Corrected on Site

Compliance Date: 2/24/2026

5 CSR 25-500.087 Fire Safety

Violation: The means of egress in the upstairs Preschool Room was obstructed in that a book shelf and light was located in front of the door.

Rule Reference: 5 CSR 25-500.087 Fire Safety (1) (M) states: Means of egress is a continuous and unobstructed way of travel from any point in a building or structure to a public way. A means of egress consists of three (3) distinct parts: the exit access, the exit, and the exit discharge;

Correction Required: Means of egress must be unobstructed.

Correction Verification: Corrected on Site

Compliance Date: 2/24/2026

5 CSR 25-500.092 Furniture, Equipment and Materials

Violation: Outdoor equipment, ride on train, in the outdoor play area was not in good condition as evidenced by the wheels were cracked.

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: 2/24/2026

5 CSR 25-500.092 Furniture, Equipment and Materials

Violation: Stationary equipment, race car, was unsafe as evidenced by the equipment had exposed footings.

Rule Reference: 5 CSR 25-500.092 Furniture, Equipment and Materials (3) (D) states: Stationary equipment such as swings, slides and climbers shall be securely anchored, have no exposed footings and be placed to avoid accidents or collisions.

Correction Required: Stationary equipment shall be safely installed, stable and securely anchored.

Correction Verification: Corrected on Site

Compliance Date: 2/24/2026

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 one child eleven months of age was asleep with a pacifier mechanism clipped to them.

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: 2/24/2026

5 CSR 25-500.092 Furniture, Equipment and Materials

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

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

Correction Required: Safe and secure feeding equipment shall be provided as required.

Correction Verification: Corrected on Site

Compliance Date: 2/24/2026

5 CSR 25-500.102 Personnel

Violation: Madison Williams did not complete safe sleep training within 30 days of employment or volunteering at the facility.

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

Correction Required: The department-approved safe sleep training must be completed within 30 days of employment or volunteering.

Correction Verification: Return Inspection

5 CSR 25-500.122 Medical Examination Reports

Violation: Medical examination report(s) was/were not on file for Madison Williams 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: Return Inspection

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: Madison Williams.

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: Return Inspection

5 CSR 25-500.122 Medical Examination Reports

Violation: Medical examination report form did not contain all required information as evidenced by the facility used the correct form; however, the medical provider failed to select whether or not the staff was in good physical and emotional health and free of contagious diseases.

Rule Reference: 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.

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

Correction Verification: Corrected on Site

Compliance Date: 2/24/2026

5 CSR 25-500.192 Health Care

Violation: The requirements for prescription medications were not met as evidenced by a medication was not labeled with the child's name.

Rule Reference: 5 CSR 25-500.192 Health Care (3) (C) states: Prescription medication shall be in the original container and labeled with the child's name, instructions for administration, including the times and amounts for dosages and the physician's name. This may include sample medication provided by a physician.

Correction Required: Medications shall be stored and labeled as required.

Correction Verification: Corrected on Site

Compliance Date: 2/24/2026

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 two TV cords upstairs, three TV cords downstairs, one lamp cord downstairs and one camera cord downstairs were not secure.

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: Corrected on Site

Compliance Date: 8/19/2025

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

Violation: The requirements for protective outlet covers or twist-lock outlets were not met as evidenced by electrical outlets were not covered in that one outlet upstairs and one outlet downstairs were missing protective outlet covers.

Rule Reference: 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (G) states: Protective outlet covers or twist-lock outlets shall be used in areas accessible to the children.

Correction Required: The facility shall use outlet covers or twist-lock outlets as required.

Correction Verification: Corrected on Site

Compliance Date: 8/19/2025

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: Glass Cleaner, Multi-Surface Cleaner and a mop bucket with water. The item(s) was/were located upstairs near the bathrooms.

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: 8/19/2025

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: Corrected on Site

Compliance Date: 8/19/2025

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: a tote full of sunscreen. The item(s) was/were located behind a desk in the upstairs area.

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: 8/19/2025

5 CSR 25-500.092 Furniture, Equipment and Materials

Violation: Furniture/equipment, one cot, in the upstairs area was not in good condition as evidenced by one long side of the cot was torn.

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

Correction Required: The facility shall provide safe and clean furniture/equipment as required.

Correction Verification: Corrected on Site

Compliance Date: 8/19/2025

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

Violation: The fall-zone area under and around outdoor equipment where children might fall and be injured was not covered with impact-absorbing materials to cushion a fall as evidenced by the resilient material used is unapproved in that several pieces of chat gravel was mixed in with the pea gravel. This was located on the playground used by children two years of age and younger.

Rule Reference: 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (6) (A) 5. states: The fall-zone area under and around outdoor equipment where children might fall and be injured shall be covered with impact absorbing materials which will effectively cushion the fall of a child. This material may include sand, pea gravel, tanbark, shredded tires, wood chips, rubber matting or other approved resilient material.

Correction Required: The facility shall maintain approved resilient material in all fall-zone areas.

Correction Verification: Submit Documentation

Compliance Date: 2/4/2025

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

Violation: The observed surface area under the pergola with swings and the red slide connected to the treehouse, from which a child might fall consists of concrete.

Rule Reference: 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.

Correction Required: The facility shall not use concrete, asphalt, carpet, grass or bare soil under equipment from which a child might fall.

Correction Verification: Submit Documentation

Compliance Date: 2/4/2025

5 CSR 25-500.102 Personnel

Violation: The requirements for obtaining 12 clock hours each calendar year were not met. For the calendar year of 2024, the staff listed need the following information: Colleen Bess - 4, Jessica Boley - 3, Abby Capone - 1.5, Janie Currington - 6, Katy Fowler - 1, Kheira Gilchrist - 5, Trinity Grisham - 3.50, Paula Henson - 12, Alexandria Kimbrough - 6, Jaelynn Royer - 4.5, Brianna Schutte - 4, Jessica Skiles - 5, Kerensa Stone - 10 & Breanna Sutton - 12.

Rule Reference: 5 CSR 25-500.102 Personnel (3) (A) states: The center director, group child care home provider, all other caregivers, and those volunteers who are counted in staff/child ratios shall obtain at least twelve (12) clock hours of child-care related training during each calendar year. Clock hour training shall be approved by the department.

Correction Required: Required training hours shall be documented for each caregiver.

Correction Verification: Submit Documentation

Compliance Date: 2/18/2025

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: Paula Henson & Jessica Skiles.

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: 2/11/2025

5 CSR 25-600.020 General Requirements

Violation: Criminal background check results were older than five (5) years for Paige Dunn & Ashley Smith.

Rule Reference: 5 CSR 25-600.020 General Requirements (5) states: Criminal background checks shall be completed for each child care staff member every five (5) years.

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

Correction Verification: Submit Documentation

Compliance Date: 2/11/2025

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

Violation: The requirements for protective outlet covers or twist-lock outlets were not met as evidenced by an electrical plate was broken in that one plate located in the Toddler Room was broken off and cracked at the top of the plate.

Rule Reference: 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (1) (G) states: Protective outlet covers or twist-lock outlets shall be used in areas accessible to the children.

Correction Required: The facility shall use outlet covers or twist-lock outlets as required.

Correction Verification: Corrected on Site

Compliance Date: 1/28/2025

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

Violation: The fall-zone area under and around outdoor equipment where children might fall and be injured was not covered with impact-absorbing materials to cushion a fall as evidenced by the resilient material used is unapproved in that several pieces of chat gravel was mixed in with the pea gravel. This was located on the playground used by children two years of age and younger.

Rule Reference: 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (6) (A) 5. states: The fall-zone area under and around outdoor equipment where children might fall and be injured shall be covered with impact absorbing materials which will effectively cushion the fall of a child. This material may include sand, pea gravel, tanbark, shredded tires, wood chips, rubber matting or other approved resilient material.

Correction Required: The facility shall maintain approved resilient material in all fall-zone areas.

Correction Verification: Submit Documentation

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

Violation: The observed surface area under the pergola with swings and the red slide connected to the treehouse, from which a child might fall consists of concrete.

Rule Reference: 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.

Correction Required: The facility shall not use concrete, asphalt, carpet, grass or bare soil under equipment from which a child might fall.

Correction Verification: Submit Documentation

5 CSR 25-500.102 Personnel

Violation: The requirements for obtaining 12 clock hours each calendar year were not met. For the calendar year of 2024, the staff listed need the following information: Colleen Bess - 4, Jessica Boley - 3, Abby Capone - 1.5, Janie Currington - 6, Katy Fowler - 1, Kheira Gilchrist - 5, Trinity Grisham - 3.50, Paula Henson - 12, Alexandria Kimbrough - 6, Jaelynn Royer - 4.5, Brianna Schutte - 4, Jessica Skiles - 5, Kerensa Stone - 10 & Breanna Sutton - 12.

Rule Reference: 5 CSR 25-500.102 Personnel (3) (A) states: The center director, group child care home provider, all other caregivers, and those volunteers who are counted in staff/child ratios shall obtain at least twelve (12) clock hours of child-care related training during each calendar year. Clock hour training shall be approved by the department.

Correction Required: Required training hours shall be documented for each caregiver.

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: Paula Henson & Jessica Skiles.

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 25-600.020 General Requirements

Violation: Criminal background check results were older than five (5) years for Paige Dunn & Ashley Smith.

Rule Reference: 5 CSR 25-600.020 General Requirements (5) states: Criminal background checks shall be completed for each child care staff member every five (5) years.

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

Correction Verification: Submit Documentation

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 one TV and one TV cord located in the Two Year Old Room was not secure.

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: Return Inspection

Compliance Date: 8/26/2024

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

Violation: There was no pad or mat under indoor equipment, a climbing ladder is 36 inches high and is located in the Two Year Old Room.

Rule Reference: 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (2) (A) 8. states: Floor surfaces under indoor equipment over twenty-four inches (24") in height, from which children might fall and be injured, shall be protected with pads or mats which will effectively cushion the fall of a child. Carpeting alone is not an acceptable resilient surface under indoor equipment.

Correction Required: Pads or mats shall be in place as required.

Correction Verification: Return Inspection

Compliance Date: 8/26/2024

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

Violation: There was no pad or mat under indoor equipment, a slide is 27 inches high and is located in the Two Year Old Room.

Rule Reference: 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (2) (A) 8. states: Floor surfaces under indoor equipment over twenty-four inches (24") in height, from which children might fall and be injured, shall be protected with pads or mats which will effectively cushion the fall of a child. Carpeting alone is not an acceptable resilient surface under indoor equipment.

Correction Required: Pads or mats shall be in place as required.

Correction Verification: Return Inspection

Compliance Date: 8/26/2024

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 one TV and one TV cord located in the Two Year Old Room was not secure.

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: Return Inspection

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

Violation: There was no pad or mat under indoor equipment, a slide is 27 inches high and is located in the Two Year Old Room.

Rule Reference: 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (2) (A) 8. states: Floor surfaces under indoor equipment over twenty-four inches (24") in height, from which children might fall and be injured, shall be protected with pads or mats which will effectively cushion the fall of a child. Carpeting alone is not an acceptable resilient surface under indoor equipment.

Correction Required: Pads or mats shall be in place as required.

Correction Verification: Return Inspection

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

Violation: There was no pad or mat under indoor equipment, a climbing ladder is 36 inches high and is located in the Two Year Old Room.

Rule Reference: 5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers (2) (A) 8. states: Floor surfaces under indoor equipment over twenty-four inches (24") in height, from which children might fall and be injured, shall be protected with pads or mats which will effectively cushion the fall of a child. Carpeting alone is not an acceptable resilient surface under indoor equipment.

Correction Required: Pads or mats shall be in place as required.

Correction Verification: Return Inspection

5 CSR 25-500.102 Personnel

Violation: A Junior Aide, Jaelynn Royer, was counted toward infant/toddler staff/child ratios.

Rule Reference: 5 CSR 25-500.102 Personnel (1) (C) 1. C. states: Shall not count towards infant/toddler staffing ratios.

Correction Required: Junior Aides shall not be counted toward infant/toddler staff/child ratios.

Correction Verification: Corrected on Site

Compliance Date: 8/14/2024