MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
YMCA-EMERSON BRANCH-KEEVEN ELEMENTARY

Facility DVN
000180638

Phone
(314) 953-4475

Physical Address
11230 OLD HALLS FERRY RD
ST LOUIS
MO 63136

Owner
GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

Mailing Address
3390 PERSHALL RD
ST LOUIS COUNTY
MO 63135

Provider/Director
COLLINS, KOLBY BROOKE

E-mail Address
mark.pacatte@gwrymca.org

Incorporated
Incorporated

Child Care Specialist
DENISE ELAYNE KOCH

Age Range
5 YEARS - 13 YEARS

Capacity
20

Facility Type
SCHOOL AGE

Limitations
BEFORE AND AFTER SCHOOL CARE ONLY

Inspection Information

Date
05/23/2017

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2304658195

Document	Document-Date
LOCAL FIRE DEPARTMENT NOTIFICATION	05/05/2017
JOB RESPONSIBILITIES	05/05/2017
DISCIPLINE POLICIES	05/05/2017
DIRECTOR'S JOB RESPONSIBILITIES	05/05/2017
REGISTERING FICTITIOUS NAMES	11/15/2012
SAMPLE FORMS	01/25/1985
LINES OF ADMINISTRATIVE AUTHORITY	10/24/2012
DIRECTOR'S QUALIFICATIONS	10/01/2012
CERTIFICATE OF INCORPORATION	01/25/1985
ARTICLES OF INCORPORATION	01/25/1985
SAMPLE WEEKLY MENU	01/25/1985
CHILD CARE PRACTICES	01/25/1985
DAILY SCHEDULE	10/24/2012
POLICIES	01/25/1985
CERTIFICATE OF GOOD STANDING	11/14/2016
STAFF SHEET	11/14/2016
EQUIPMENT LIST	11/14/2016
APPLICATION	11/09/2016

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.