DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

TWIN PIKE FAMILY YMCA

001779428

(573) 754-6904

500 HALEY AVE
LOUISIANA
MO  63353

TWIN PIKE FAMILY YMCA

614 KELLY LN
LOUISIANA
MO  63353-2409

SHEPHERD, NOVETA A

BROOKSM@LOUISIANA.K12.MO.US

Incorporated

WENDI MATLICK

5 YEARS - 13 YEARS

96

SCHOOL AGE

 
Inspection Information

03/21/2016

4:00 PM

4:32 PM

UNANNOUNCED

COMPLIANCE MONITORING

2276295588


DocumentDocument-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
StaffChildClass AgeNote
9 71 SCHOOL AGE Benita Asquith, Christine Barber, Jeremy Booth, Melinda Brooks, Brittany Cole, Ann Murry, Noveta Shepherd, Christina Hoskins and Loretta Woodward

 
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
Violation
 Provider Comments
Violation
The provider did not meet requirements for requests/results of background reviews. Reviews were missing/out of date for the following owner(s), board president or chairperson, center director or group day care home provider, employees or volunteers counted in staff/child ration: Ann Murry.
Licensing Rule Reference
19 CSR 30-62.102 Personnel (1) (L) states: 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 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. Requests for criminal record reviews shall be made on a form provided by the highway patrol.
Correction Required
Required requests/results of current background checks shall be on file.

Correction Verification
Corrected on Site

Compliance Date
3/21/2016
19 CSR 30-62.112 Staff/Child Ratios
Compliance
19 CSR 30-62.122 Medical Examination Reports
Violation
 Provider Comments
Violation
Medical examination report was not on file for Ann Murry as evidenced by a medical examination was not on file within 30 days of an individual beginning to work with children.
Licensing Rule Reference
19 CSR 30-62.122 Medical Examination Reports (1) (A) states: All persons working in a day 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
Corrected on Site

Compliance Date
3/21/2016
Violation
Medical examination report did not include a completed Risk Assessment for Tuberculosis form.
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
Corrected on Site

Compliance Date
3/21/2016
19 CSR 30-62.132 Admission Policies and Procedures
Compliance
19 CSR 30-62.172 Emergency School Closings
Not Observed
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
Not Observed
19 CSR 30-62.212 Transportation and Field Trips
Compliance
19 CSR 30-62.222 Records and Reports
Compliance
RSMo 210.003 Immunizations of children required, when, exceptions--duties of administrator, report--notification of parents, when.
Compliance