MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
TWIN PIKE FAMILY YMCA

Facility DVN
001779428

Phone
(573) 754-6904

Physical Address
500 HALEY AVE
LOUISIANA
MO 63353

Owner
TWIN PIKE FAMILY YMCA

Mailing Address
614 KELLY LN
LOUISIANA
MO 63353-2409

Provider/Director
SHEPHERD, NOVETA A

E-mail Address
BROOKSM@LOUISIANA.K12.MO.US

Incorporated
Incorporated

Child Care Specialist
WENDI MATLICK

Age Range
5 YEARS - 13 YEARS

Capacity
96

Facility Type
SCHOOL AGE

Limitations

Inspection Information

Date
03/21/2016

Arrival Time
4:00 PM

Departure Time
4:32 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2276295588

Document	Document-Date
APPLICATION	09/08/2015
SAMPLE FORMS	09/05/2003
LINES OF ADMINISTRATIVE AUTHORITY	08/27/2007
POLICIES	09/05/2003
SAMPLE WEEKLY MENU	09/05/2003
DAILY SCHEDULE	06/01/2004
CERTIFICATE OF GOOD STANDING	09/24/2013
DIRECTOR'S QUALIFICATIONS	09/24/2013

Inspection determined facility to be in compliance with licensing rules.

Open Violations: NA

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 9

Total Children 71

Staff	Child	Class Age	Note
9	71	SCHOOL AGE	Benita Asquith, Christine Barber, Jeremy Booth, Melinda Brooks, Brittany Cole, Ann Murry, Noveta Shepherd, Christina Hoskins and Loretta Woodward