Health care for childrens: basic information.
What should I look for when choosing child care?
Information is available at Child Care Aware of Missouri (Resource and Referral).
How can I get a list of child care providers in my area?
A list of licensed and license-exempt child care providers is available at Child Care Provider Search and through your regional resource and referral agency Child Care Aware of Missouri.
What inspection requirements do licensed and license-exempt facilities have?
Both licensed and license-exempt facilities are required to have regular fire, sanitation and health inspections. In addition, licensed facilities have additional compliance monitoring inspections each year.
Do all persons who care for children (who are not related to the provider) in their homes have to be licensed by the state?
No. A person may care for four or fewer children who are not *related to the provider without being licensed.
What should I do if I notice an in-home provider is caring for more than four (4) unrelated children?
Providing unlicensed child care for more than 4 children, who are not *related to the provider, is against the law in Missouri. If you know someone who is providing illegal care, contact us and file a complaint.
How many children may a licensed facility care for at one time?
There are several criteria that determine a facilitys licensed capacity. These include:
- Square footage for indoor and outdoor areas;
- Directors education and work experience; and
- Amount of materials and equipment.
What happens if my child gets sick while they are at the licensed facility?
Child care rules document what symptoms require providers to observe children more closely and what symptoms require that providers send children home. Your provider is required to contact you when signs of illness are observed.
How will I learn about the providers rules and policies?
A licensed child care facility is required to provide the parents with written policies, program goals, admission, care and discharge of the child at the time of enrollment. The provider must also have a copy of the child care licensing rules available for review. License-exempt providers are required to give parents a Notice of Parental Responsibility which includes the facilitys discipline philosophy and policy, facilitys staff/child ratio, and the educational philosophy and policy. Sec. 210.254, RSMo
Can my provider give medications to my child?
The center or home provider is not required to administer medication. However, if your provider chooses to administer medication, there are guidelines in the rules that must be followed for licensed and license-exempt child care providers.
What happens if my provider breaks a rule?
When it is determined that the provider is not in compliance, the provider is notified at the time of inspection. If there is a consistent pattern of non-compliance or areas that present a danger to the health, safety and welfare of children, disciplinary action will be taken.
What types of disciplinary action can be taken?
Disciplinary actions include the following:
Denial of Initial License - A formal action notifying a person why he or she cannot receive a child care license, taken when an applicant for initial license does not comply with statute or licensing rule requirements.
Denial of Renewal - A formal action notifying a person why the child care license will not be renewed at the expiration of the licensing period. This action occurs when the licensee does not comply with statute and licensing rule requirements.
Letter of Warning - Formal correspondence that notifies a licensee that violations have occurred. It is removed from public record after one year.
Letter of Censure - Formal correspondence that notifies a licensee that violations have occurred. It is filed permanently in the public record.
Probation - Places conditions or terms on a license that may exceed the licensing rule requirements for a specific period of time. It may lead to further discipline if the licensee fails to comply with the terms of the probationary license.
Settlement Agreement - This is a negotiation process by which we and the licensee finalize a formal agreement on specific terms or conditions to allow continuation of the license.
Immediate suspension - This is the only action taken by us that immediately terminates the licensed status. This occurs in situations of imminent bodily harm to children.
Revocation - This is a formal action that removes a child care license.
Injunctive Relief - This is a court order that causes a person to cease operating a child care facility or imposes conditions to protect children who are in care at the facility from imminent danger.
Referral to the Prosecuting Attorney - Our action when there is evidence of a statute violation for care of more than 4 children not related to the caregiver without a license.
What will my provider do in an emergency if I cannot be reached?
The provider is required to obtain emergency contact information at the time of enrollment. The provider will typically try to contact the parent first, and if the parent cannot be reached, the persons listed as the emergency contacts will be called. You should review your emergency contacts periodically to ensure your provider has updated information.
What is a ratio?
The amount of staff, required by licensing rules, per child required in a licensed facility. In license-exempt facilities, the owner/operator defines the ratio.
What are the ratios for group home and child care centers?
The following staff/child ratios apply to group child care homes and child care centers:
- Birth to 2 years - 1 caregiver for every 4 children
- 2 year olds 1 caregiver for every 8 children
- 3 to 5 year olds 1 caregiver for every 10 children
- Ages 5 years and up - 1 caregiver for every 16 children
- Special requirements apply for mixed age groups.
What is the capacity for family home providers?
The number of children and the ages of the children in care is defined on the family home providers license which must be posted at the facility. A family home provider is limited to caring for no more than ten *unrelatedchildren. The number of *unrelated children under the age of two will affect the total number of children allowed.
How do I find out about complaints made against a provider?
When you tour the facility, ask to see copies of current inspection reports. We maintain copies of inspection reports, substantiated complaints and other licensing information. You can view a copy of a child care facilitys licensing record by contacting the child care licensing office. All complaints are investigated, but only substantiated complaints are placed in the providers public record.
How do I file a complaint?
You can file a complaint by contacting the child care licensing office. A complaint form is available, but the form is not required. We also accepts complaints by telephone. For more information about how to file a complaint,click here. When filing a complaint, please be prepared to give as much detail as possible. This will assist us in gathering the information needed to conduct a thorough investigation.
How often are providers inspected?
Licensed facilities are inspected at least once annually by staff from:
- Fire safety; and
- Environmental sanitation.
Licensed facilities are inspected at least twice annually by staff from:
License exempt facilities are inspected once annually by staff from:
- Fire safety;
- Environmental sanitation; and
Unregulated facilities are not inspected by Section for Child Care Regulation.
Can a facility disenroll my child?
Yes. Refer to your providers written policies and procedures. Each regional resource and referral office has an Inclusion Specialist who can work with the provider and parent before dis-enrollment occurs. For assistance, contact your regional resource and referral office (Child Care Aware of Missouri).
Can the provider transport my child?
We have rules that licensed and license-exempt providers must follow. The provider is responsible for the care, safety and supervision of children on field trips or any other time the children are transported away from the facility. Parents must be informed when field trips are planned and written parental consent must be on file for all field trips and transportation. Drivers and vehicles must meet the requirements of Missouri law. Child safety restraints must be used according to Missouri state law.
What are the general differences between licensed, license-exempt and unregulated facilities?
Download this pdf to view a chart of general differences in unregulated child care facilities.
How can I find child care for a child with special needs?
Contact United 4 Children at 1-800-467-2322. You will be connected to an Inclusion Specialist who will assist your family in finding care specific to the special needs of your child. If your question has not been answered, email firstname.lastname@example.org.
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Child Care Provider Information FAQ Section
Once I get my child care license, what changes impact my license?
Issues such as change in ownership, change in location, change in capacity, or a change in hours (adding care after 9 p.m.) can affect a child care license. Prior to making changes that you believe could affect your licensing status, you must contact us.
How long do I have to complete the application process?
An application is valid for six months. If your facility is not licensed within that timeframe, you will need to complete a new application.
Are child care licenses permanent?
No. A child care license can be issued for a maximum of a two year period.
How many children can I care for without being licensed?
Missouri state law allows you to care for no more than four children not *related to you without a child care license.
What type of training do I need on a yearly basis?
The director, child care providers, all caregivers and volunteers who are counted in staff/child ratios of licensed family child care homes, group child care homes and child care centers are required to obtain at least 12 approved clock hours of child care related training during each calendar year.
We contract with qualified training organizations to provide accessible and affordable training for child care providers across the state. The training must be based on competencies (essential knowledge and skill areas) for assuring quality child care. Child care related training topics include: health, safety, nutrition, developmentally appropriate activities and learning experiences for children; positive guidance and discipline; positive communication and interaction with families; planning and setting up an appropriate environment for children; professional and administrative practices.
Child care training and professional development opportunities include:
- Training workshops on various topics;
- Child Development Associate (CDA) training and assessment to assist child care providers earn a national CDA credential from the Council for Early Childhood Professional Recognition;
- College credit training from some colleges and universities;
- Advanced and specialized training for entry level child care staff, directors, infant/toddler caregivers, and caring for children with special needs; and
- Individualized technical assistance and training to assist providers to access needs and make improvements in their respective programs.
For a list of approved trainings and professional development, contact Child Care Aware of Missouri at 800-200-9017. Click on Training & Professional Development, then choose the training calendar in your area.
Are there grants or funding available to operate my child care program?
We do not provide grants or funding, however there are other resources that may be available to you.
- The Child Care Food Program
- Department of Social Services, Child Care Subsidy
- Department of Elementary and Secondary Education
- Child Care Aware® of Missouri
- T.E.A.C.H. Scholarship
What happens if I don´t get licensed and I care for more than four (4) children who are not related to me?
If we determine that you are providing care to more than four (4) children not *related to you, we will expect you to immediately limit the number of children in your care to 4 or fewer in compliance with Missouri law. Parents of children in your care will be notified if you are operating illegally. Additionally, local law enforcement will be notified. Legal referrals may also be made to the local prosecuting attorney for further action.
Is there a fee for a license?
The State of Missouri does not charge a fee, but you may incur costs to meet required rules. (Examples include install a fence, obtain a medical examination, etc.) In addition, you will need to contact your local city or county to determine if any fees apply to your business.
What types of inspections do I need to obtain a child care license?
- Fire safety
How long does it take to get licensed?
The exact time to become licensed varies depending on how quickly the applicant is able to meet the licensing rules. The licensing process includes inspections by the Department of Health and Senior Services, Section for Child Care Regulation, Bureau of Environmental Regulation and Licensure, and the Department of Public Safety, Division of Fire Safety. There may also be local building and zoning ordinances that apply. Therefore, it is advisable to begin the licensing process as soon as possible.
What are the educational requirements for a licensed group home or child care center director?
Click here to view a chart of the educational requirements.
What is a registered provider?
Some families may be eligible for financial help with their child care costs. The Department of Social Services, Family Support Division may contract with licensed and license-exempt providers to pay for child care services for eligible children. If you are interested in this program, contact your local county Family Support Division office.
What should I do if I suspect child abuse or neglect (CA/N)?
Child care providers are mandated (required) by law to report any suspicion of child abuse or neglect. These reports must be made to the Child Abuse and Neglect (CA/N) hotline at 1-800-392-3738.
Why does the Section for Child Care Regulation do background screenings?
Our rules require background screenings. We have adopted a policy to address background screenings. The following rules and statutes provide the authority for the section to conduct background screenings.
19 CSR 30-62.102(1)(A) states:
Day care personnel shall be of good character and intent and shall be qualified to provide care conducive to the welfare of children. Similar rules for family homes exist 19 CSR 30-61.105(1)(D)
19 CSR 30-62.102(1) (K) states:
Volunteers counted in staff/child ratios, caregivers and other personnel shall be screened for child abuse/neglect. The screening shall be requested by the provider within ten (10 days) of any individual beginning employment or volunteering in the facility. Any investigated allegation of child abuse or neglect in which the investigator finds reasonable cause to believe that the individual is the alleged perpetrator of child abuse or neglect, shall be evaluated by the department. After review, the department may prohibit the person from being present in the facility during child care hours. Similar rules for family homes exist 19 CSR 30-61.105(1)(K)
19 CSR 30-62.102(1)(L) states in part:
The child care provider shall request and have on file the results of a criminal record review from the Missouri State Highway Patrol as defined by 19 CSR 30-62.042 Initial Licensing Information and 19 CSR 30-62.052 License Renewal. The child care provider shall request a criminal record review within ten (10) days following a change of the facility owner(s), board president or chairperson, the center director or group day care home provider, employees of the provider, or volunteers counted in the staff/child ratios. The department may request a criminal record review from the Missouri State Highway Patrol for any adult present in the facility when child care children are present. The criminal record reviews shall include records of criminal convictions, pending criminal charges, and suspended imposition of sentence during the term of probation.
2. Any information received by the department that indicates that the subject of the criminal record review poses a threat to the safety or welfare of children shall be evaluated by the department. After review, the department may prohibit such person from being present on the premises of the facility during child care hours. Similar rules for family homes exist 19 CSR 30-61.105(1)(L)
19 CSR 30-62.102(1)(M) states: Any person present at the facility during the hours in which child care is provided shall not present a threat to the health, safety or welfare of the children Similar rules for family homes exist 19 CSR 30-61.115(5)
Section 210.221, RSMo sets for the powers and duties of the department concerning child care licensing.
Section 210.906, RSMo requires every child care worker hired on or after Jan. 1, 2001 to complete registration with the Family Care Safety Registry.
Section 210.922, RSMo allows the department to use information contained in the Family Care Safety Registry to carry out its statutory duties.
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Environmental Sanitation FAQ Section
I am interested in opening a new child care facility or home, who should I contact?
The Missouri Department of Health and Senior Services Section for Child Care Regulation will assist potential child care providers in getting started with the initial licensing process. Once the prospective provider has completed an application for licensure, the Section for Child Care Regulation will notify the Division of Fire Safety and Environmental Child Care Program of the providers need for initial inspections.
How often are child care providers inspected?
For sanitation, child care providers are inspected at least annually. Providers that routinely fail to meet sanitation requirements may be inspected more frequently.
Who conducts child care sanitation inspections?
Inspections may be conducted by Environmental Public Health Specialists from the Department of Health and Senior Services Environmental Child Care Program or from the Local Public Health Agency.
How do I file a sanitation complaint regarding a child care facility or home?
You can file a complaint by contacting the child care licensing office. A complaint form is available, but the form is not required. The Section for Child Care Regulation also accepts complaints by telephone. For more information about how to file a complaint, click here. When filing a complaint, please be prepared to give as much detail as possible. This will assist the Section in gathering the information needed to conduct a thorough investigation. The Environmental Child Care Program assists the Section for Child Care Regulation in investigating complaints as needed.
Are there differences in sanitation requirements for licensed family homes, group homes, centers, and license-exempt facilities?
Yes, there are a number of differences in sanitation requirements for the different types of child care in Missouri. Please refer to the sanitation guidelines or contact us for questions about specific issues.
What do child care sanitation inspectors look for?
Child care sanitation inspectors conduct thorough inspections to ensure the health and safety of children in care. Inspectors evaluate cleanliness, facility maintenance, water and sewer services, hygiene, food protection, diapering, and other various procedural issues that promote a healthy environment.
Is lead-based paint allowed in child care?
Prior to 1978 lead-based paint was widely used, and any pre-1978 structure may contain lead-based paint. It is important to understand the difference between lead-based paint and a lead hazard. Lead hazards are not permitted in child care, but the simple existence of lead-based paint does not necessarily constitute a lead hazard. Lead-based paint that is deteriorating or on a friction surface are examples of a lead hazard that is not permitted in child care.
What are the sanitation requirements for having pets in child care?
All animals must be considered to be in good health. Pets such as cats and dogs should be routinely evaluated by a veterinarian and vaccinated according to the veterinarians recommendations or as required by local ordinance. Birds of the parrot family must be tested for psittacosis. Reptiles are prohibited in child care. Other animals are evaluated on a case-by-case basis.
NOTE: the Section for Child Care Regulation also has safety requirements for animals in child care.
What is considered an approved food source in child care?
Child care providers must utilize foods from an approved source. The following are examples of approved sources:
- Schools and restaurants
- Grocery and other retail food stores
- Commercial food warehouses and distributors
- Local farmers market for whole, uncut fruits and vegetables
- Providers garden for whole, uncut fruits and vegetables
The following are examples of unapproved food sources:
- Custom-exempt processed beef and pork
- Wild game
- Farm fresh eggs from individuals without a valid egg license from the Missouri Department of Agriculture
- Unpasteurized milk
- Home-canned foods
- Foods prepared at an uninspected facility such as an employees home
If you have questions regarding approved food sources, contact us or your local public health agency.
What are the expectations for a child care provider operating under a boil water order?
Depending on the type of water supply, a boil water order may be issued by DHSS, Local Public Health Agency, Department of Natural Resources, or the water supplier. A boil water order indicates that the water may not be safe for consumption. Child care providers are expected to follow boil water orders to protect children in care. If you have questions regarding a boil water order, contact us or your local public health agency.
Why is the required cleaning process so complicated?
Certain surfaces are required to be washed, rinsed, sanitized, and air-dried. The process ensures that surfaces of critical importance such as diapering pads are not only clean to sight and touch, but free of harmful microorganisms as well.
Where can I get sanitizer test strips for my child care?
Providers are required to have a test kit for testing sanitizer solution concentrations. Restaurant supply stores are generally considered the best place to obtain test strips for the various approved sanitizers.
What is date-marking?
Date-marking certain foods is required for most child care providers. Refrigerated foods prepared at the facility that are potentially hazardous, ready-to-eat, and held over 24 hours must be labeled with a discard-by date of the preparation day plus seven days. Commercially processed, refrigerated food items that are potentially hazardous, ready-to-eat, and held over 24 hours must also be date-marked once the product has been opened. If you have questions about which foods require date-marking, contact us or your local public health agency.
Why is hand washing so important?
Good hand washing is the single most important thing a child care provider can do to prevent the spread of disease. It is critical that provider and child alike learn to wash their hands frequently.