DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

YMCA- EMERSON BRANCH- JAMESTOWN ELEMENTARY

001873398

(314) 452-3065

13750 OLD JAMESTOWN ROAD
ST LOUIS
MO  63033

GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

3390 PERSHALL RD
ST LOUIS
MO  63135

WILLIAMS, TIFFANY MICHELLE

mark.pacatte@gwrymca.org

Incorporated

DENISE ELAYNE KOCH

5 YEARS - 13 YEARS

20

SCHOOL AGE

20 SCHOOL-AGE CHILDREN DURING THE SCHOOL YEAR; 20 SCHOOL-AGE CHILDREN DURING THE SUMMER
 
Inspection Information

03/29/2016

7:30 AM

8:13 AM

UNANNOUNCED

COMPLIANCE MONITORING

2276935551


DocumentDocument-Date
DISCIPLINE POLICIES 03/26/2012
SAMPLE WEEKLY MENU 03/26/2012
DIRECTOR'S QUALIFICATIONS 12/23/2015
LINES OF ADMINISTRATIVE AUTHORITY 03/26/2012
CHILD CARE PRACTICES 03/26/2012
ARTICLES OF INCORPORATION 03/26/2012
JOB RESPONSIBILITIES 03/26/2012
DAILY SCHEDULE 03/26/2012
POLICIES 03/26/2012
CERTIFICATE OF GOOD STANDING 09/08/2012
STAFF SHEET 10/02/2014
EQUIPMENT LIST 10/02/2014
APPLICATION 09/08/2014




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 4
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 2
Total Children 8
StaffChildClass AgeNote
2 8 SCHOOL AGE Terry Norman and Marilyn Dilworth present.

 
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
Not Observed
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
Compliance
19 CSR 30-62.132 Admission Policies and Procedures
Violation
 Provider Comments
Violation
An individualized plan for specialized care for a child with special physical, developmental or behavioral needs was not met as evidenced by there was no plan on file for a child with special needs.
Licensing Rule Reference
19 CSR 30-62.132 Admission Policies and Procedures (6) states: A child who has a special physical, developmental or behavioral need shall have on file an individualized plan for specialized care from a professionally qualified source.
Correction Required
An individualized plan from a professional source shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

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
Not Observed
19 CSR 30-62.212 Transportation and Field Trips
Compliance
19 CSR 30-62.222 Records and Reports
Violation
 Provider Comments
Violation
The facility did not meet requirements for child enrollment and health information on file as evidenced by 1 child(s) file did not have the full name of the parent(s), guardian or legal custodian, home address, employers’ name and address, work schedule and home and work telephone numbers.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility did not meet requirements for child enrollment and health information on file as evidenced by 1 child(s) file did not have the name and phone number of the family physician, or hospital, or both.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (2) (D) states: Name and phone number of the family physician, hospital, or both, to be used in an emergency;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility did not meet requirements for child enrollment and health information on file as evidenced by 1 child(s) file did not have the field trip and transportation authorization.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (2) (F) states: Field trip and transportation authorization.
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

RSMo 210.003 Immunizations of children required, when, exceptions--duties of administrator, report--notification of parents, when.
Compliance