DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

YMCA- EMERSON BRANCH -JURY ELEMENTARY

000180610

(314) 452-5146

11950 OLD HALLS FERRY
BLACK JACK
MO  63033

GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

3390 PERSHALL RD
ST LOUIS COUNTY
MO  63135

BURT, PAULA NICHELLE

mark.pacatte@gwrymca.org

Incorporated

DENISE ELAYNE KOCH

5 YEARS - 13 YEARS

20

SCHOOL AGE

BEFORE AND AFTER SCHOOL CARE ONLY
 
Inspection Information

05/26/2017

6:39 AM

7:16 AM

UNANNOUNCED

COMPLIANCE MONITORING

2306115727


DocumentDocument-Date
LINES OF ADMINISTRATIVE AUTHORITY 11/19/2012
SAMPLE FORMS 11/19/2012
JOB RESPONSIBILITIES 11/19/2012
SAMPLE WEEKLY MENU 11/19/2012
POLICIES 11/19/2012
DISCIPLINE POLICIES 11/19/2012
DAILY SCHEDULE 11/19/2012
CERTIFICATE OF INCORPORATION 11/19/2012
CHILD CARE PRACTICES 11/19/2012
ARTICLES OF INCORPORATION 11/19/2012
REGISTERING FICTITIOUS NAMES 06/07/2012
DIRECTOR'S QUALIFICATIONS 05/15/2001
STAFF SHEET 12/12/2016
EQUIPMENT LIST 12/12/2016
APPLICATION 12/02/2016




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.
Attendance at Time of Inspection
Total Staff 3
Total Children 1
StaffChildClass AgeNote
3 1 SCHOOL AGE Paula Burt, Mary Ware, and Aileen Henderson 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
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
Violation
 Provider Comments
Violation
1 child(ren) records did not include name of family physician or hospital.
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

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