DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

YMCA-FOUR RIVERS BRANCH-AUGUSTA ELEMENTARY

001481927

(636) 239-5704

5541 LOCUST ST
AUGUSTA
MO  63332

GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

400 GRAND AVE
WASHINGTON
MO  63090-1204

MILLHEISER, MORGAN

dallas.pennock@gwrymca.org

Incorporated

DEBBIE ASHLOCK

5 YEARS - 12 YEARS

20

GROUP HOME AND CENTER

AFTER SCHOOL CARE ONLY
 
Inspection Information

01/06/2017

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2296765414


DocumentDocument-Date
APPLICATION 07/09/2016
DIAGRAM/INDOOR 11/04/2015
DIAGRAM/OUTDOOR 11/04/2015
STAFF SHEET 07/06/2016
EQUIPMENT LIST 07/06/2016
ARTICLES OF INCORPORATION 07/09/2016
CERTIFICATE OF GOOD STANDING 07/09/2016
JOB RESPONSIBILITIES 07/06/2016
DIRECTOR'S QUALIFICATIONS 07/21/2016
DAILY SCHEDULE 07/06/2016
SAMPLE WEEKLY MENU 07/06/2016
POLICIES 07/06/2016
CHILD CARE PRACTICES 07/06/2016
DISCIPLINE POLICIES 07/06/2016
SAMPLE FORMS 07/06/2016
REGISTERING FICTITIOUS NAMES 08/01/2016
LINES OF ADMINISTRATIVE AUTHORITY 08/26/2016




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.

 
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 30-62.087 Fire Safety
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 report did not include a completed Risk Assessment for Tuberculosis form for Elizabeth DeJesus.
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
1/6/2017
19 CSR 30-62.132 Admission Policies and Procedures
Compliance
19 CSR 30-62.142 Nighttime Care
Compliance
19 CSR 30-62.152 Hourly Care Facilities
Compliance
19 CSR 30-62.162 Overlap Care of Children
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
RSMo 210.003 Immunizations of children required, when, exceptions--duties of administrator, report--notification of parents, when.
Compliance