DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

TWIN PIKE FAMILY YMCA

001782674

(573) 242-3546

28176 HIGHWAY WW
CLARKSVILLE
MO  63336

TWIN PIKE FAMILY YMCA

614 KELLY LN TWIN PIKE FAMILY YMCA
LOUISIANA
MO  63353

SEWARD, MARGUERITE T

GREGORYK@CLOPTON.K12.MO.US

Incorporated

WENDI MATLICK

5 YEARS - 12 YEARS

120

SCHOOL AGE

 
Inspection Information

04/18/2013

3:00 PM

3:54 PM

UNANNOUNCED

COMPLIANCE MONITORING

2147823688


DocumentDocument-Date
APPLICATION 08/30/2011
POLICIES 09/20/2005
DAILY SCHEDULE 05/06/2008
SAMPLE WEEKLY MENU 09/10/2003
EQUIPMENT LIST 08/25/2011
CHILD CARE PRACTICES 09/20/2005
STAFF SHEET 08/25/2011
ARTICLES OF INCORPORATION 10/29/2003
DIRECTOR'S QUALIFICATIONS 10/30/2007
DIRECTOR'S JOB RESPONSIBILITIES 09/20/2005




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 1
NOTE
The licensee is responsible for compliance with all licensing rules, including but not limited to the rules listed on this compliance report form.
Attendance at Time of Inspection
Total Staff 4
Total Children 32
StaffChildClass AgeNote
4 32 SCHOOL AGE

 
19 CSR 30-62.032 Organization and Administration
Compliance
19 CSR 30-62.042 Initial Licensing Information
Compliance
19 CSR 30-62.052 License Renewal
Compliance
19 CSR 30-62.082 Physical Requirements of Group Day Care Homes and Day Care Centers
Compliance
19 CSR 30-62.090 Disaster and Emergency Preparedness
Compliance
19 CSR 30-62.092 Furniture, Equipment and Materials
Compliance
19 CSR 30-62.102 Personnel
Compliance
19 CSR 30-62.112 Staff/Child Ratios
Compliance
19 CSR 30-62.122 Medical Examination Reports
Violation
 Provider Comments
Violation
Medical examination reports including TB testing were not on file for Richele Falloon as evidenced by a completed Risk Assessment for Tuberculosis form was not on file for adults.
Licensing Rule Reference
19 CSR 30-62.122 Medical Examination Reports (1) (B) states: Medical examination reports shall include a “Risk Assessment for Tuberculosis” form, included herein, completed and signed by a health care professional, as provided by the Missouri Department of Health and Senior Services (MDHSS). If the person has signs or symptoms of tuberculosis, or risk factors for tuberculosis, then testing for tuberculosis shall occur.
Correction Required
TB reports shall be on file as required

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-62.132 Admission Policies and Procedures
Compliance
19 CSR 30-62.172 Emergency School Closings
Compliance
19 CSR 30-62.182 Child Care Program
Compliance
19 CSR 30-62.192 Health Care
Compliance
19 CSR 30-62.202 Nutrition and Food Service
Compliance
19 CSR 30-62.212 Transportation and Field Trips
Compliance
19 CSR 30-62.222 Records and Reports
Compliance