DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

YMCA FOUR RIVERS BRANCH SOUTH POINT ELEMENTARY

000198316

(314) 363-1348

2300 SOUTHBEND DR
WASHINGTON
MO  63090

GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

400 GRAND AVE
WASHINGTON
MO  63090

CARR, MCKENZIE

melissa.mueller@gwrymca.org

Incorporated

LEATRICE L DIXON

6 YEARS - 13 YEARS

48

SCHOOL AGE

AFTER SCHOOL CARE ONLY
 
Inspection Information

10/11/2017

3:20 PM

4:48 PM

UNANNOUNCED

COMPLIANCE MONITORING

2315329037


DocumentDocument-Date
STAFF SHEET 03/28/2012
SAMPLE WEEKLY MENU 08/30/2001
POLICIES 03/28/2009
LINES OF ADMINISTRATIVE AUTHORITY 06/21/1979
EQUIPMENT LIST 03/22/2012
DISCIPLINE POLICIES 03/28/2009
DIRECTOR'S JOB RESPONSIBILITIES 08/30/2001
DAILY SCHEDULE 08/17/2009
CHILD CARE PRACTICES 03/28/2009
CERTIFICATE OF INCORPORATION 08/30/2001
CERTIFICATE OF GOOD STANDING 03/23/2012
ARTICLES OF INCORPORATION 08/30/2001
APPLICATION 03/07/2012
DIRECTOR'S QUALIFICATIONS 01/24/2017




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 17
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 19
StaffChildClass AgeNote
2 19 SCHOOL AGE Jacob Nelson and CJ Mathews with children aged 5 to 11 The license is for children ages 6 through 13

 
19 CSR 30-62.032 Organization and Administration
Compliance
19 CSR 30-62.042 Initial Licensing Information
Violation
 Provider Comments
Violation
The ages of children was exceeded as evidenced by the incense is for children ages 6 through 13 years. There is a 5 year old on site.
Licensing Rule Reference
19 CSR 30-62.042 Initial Licensing Information (3) (W) states: The number and ages of children the facility is authorized to have in care at any one (1) time shall be specified on the license and shall not be exceeded except as permitted within these rules.
Correction Required
The facility's license capacity and limitations shall not be exceeded.

Correction Verification
Return Inspection

Compliance Date

Violation
Posting requirements were not met as evidenced by the license was not posted near the entrance.
Licensing Rule Reference
19 CSR 30-62.042 Initial Licensing Information (3) (O) states: The official license shall be granted for up to two (2) years and may be renewed upon reapplication and reinvestigation. Until the official license is received, the temporary license shall be posted near the entrance of the facility where it may be seen easily by parents or others who visit. Thereafter, the official license shall be posted near the entrance of the facility.
Correction Required
The facility's license shall be posted.

Correction Verification
Corrected on Site

Compliance Date
10/11/2017
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
Violation
 Provider Comments
Violation
The facility’s name, address and telephone number was not posted in each room.
Licensing Rule Reference
19 CSR 30-62.090 Disaster and Emergency Preparedness (2) (B) 1. A. states: The name, address, and telephone number of the facility;
Correction Required
Facility must post information as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility’s list of emergency numbers was not posted in each room.
Licensing Rule Reference
19 CSR 30-62.090 Disaster and Emergency Preparedness (2) (B) 1. B. states: A list of emergency numbers, including 911, if available, the fire department, police department, ambulance service, poison control center, and local radio station;
Correction Required
Facility must post information as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility’s name and phone number of the owner’s principal place of business was not posted in each room.
Licensing Rule Reference
19 CSR 30-62.090 Disaster and Emergency Preparedness (2) (B) 1. C. states: When a facility operates at more than one (1) site, the name and telephone number of the facility's principal place of business;
Correction Required
Facility must post information as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility’s name and phone number of the building’s owner/manager was not posted in each room.
Licensing Rule Reference
19 CSR 30-62.090 Disaster and Emergency Preparedness (2) (B) 1. D. states: When a facility occupies space it does not own, the name and telephone number of the owner of the building or the building manager;
Correction Required
Facility must post information as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility's evacuation route diagram was not posted in each room.
Licensing Rule Reference
19 CSR 30-62.090 Disaster and Emergency Preparedness (2) (B) 2. states: A diagram of evacuation routes from the room;
Correction Required
Facility must post information as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The facility’s special instructions for infants and non-ambulatory children were not posted in each room.
Licensing Rule Reference
19 CSR 30-62.090 Disaster and Emergency Preparedness (2) (B) 3. states: Any special instructions for infants and non-ambulatory children;
Correction Required
Facility must post information as required.

Correction Verification
Submit Documentation

Compliance Date

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 volunteers counted in staff/child ratio, caregivers or other personnel: CJ Mathews (start date on site 8.2017).
Licensing Rule Reference
19 CSR 30-62.102 Personnel (1) (K) states: Volunteers counted in staff/child ratios, caregivers, and other personnel shall be screened for child abuse/neglect. The screening shall be requested by the provider within ten (10) days of any individual beginning employment or volunteering in the facility. Any investigated allegation of child abuse or neglect involving these persons in which the investigator finds reasonable cause to believe that the individual is the alleged perpetrator of child abuse or neglect shall be evaluated by the department. After review, the department may prohibit the person from being present in the facility during child care hours. A copy of the screening request and the response shall be filed in the employee's record.
Correction Required
Required requests/results of current background checks shall be on file.

Correction Verification
Submit Documentation

Compliance Date

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: CJ Mathews (start date on site 8.2017).
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
Submit Documentation

Compliance Date

Violation
The center director was not responsible for the daily planning, monitoring and managing of the facilities program as evidence by the director left in January 2017 and there is no approved director.
Licensing Rule Reference
19 CSR 30-62.102 Personnel (2) (A) 1. states: The group day care home provider or the individual designated as the center director shall be responsible for planning, monitoring, and managing the facility's daily program.
Correction Required
Group Day Care Home provider or center director shall be responsible for the daily planning, monitoring and managing of the facilities daily operations.

Correction Verification
Submit Documentation

Compliance Date

Violation
The director is not routinely on duty as required, as evidenced by the director left in January 2017 and there is no approved director.
Licensing Rule Reference
19 CSR 30-62.102 Personnel (2) (A) 2. states: Center directors and group day care home providers routinely shall be on duty during the hours of highest attendance a minimum of forty (40) hours per week. If the facility operates less than forty (40) hours per week, the center director or group day care home provider shall be on duty at least fifty percent (50%) of the operating hours.
Correction Required
The director/group day care home provider shall be routinely on duty as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The department did not receive notification of a director change.
Licensing Rule Reference
19 CSR 30-62.102 Personnel (2) (A) 5. states: The center owner(s), or the board president or chairperson, shall notify the department immediately when there is a change of directors and shall submit child abuse/neglect screening information as required by 19 CSR 30-62.042 Initial Licensing Information.
Correction Required
The facility shall notify SCCR immediately when there is a change of directors and submit required background check request.

Correction Verification
Submit Documentation

Compliance Date

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 CJ Mathews 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
Submit Documentation

Compliance Date

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
Submit Documentation

Compliance Date

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
Compliance
19 CSR 30-62.212 Transportation and Field Trips
Compliance
19 CSR 30-62.222 Records and Reports
Violation
 Provider Comments
Violation
Three child(ren) records did not include employers' address of parent(s), guardian or legal custodian.
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
Five child(ren) records did not include address of another individual who might be reached in an emergency.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (2) (C) states: Name, address and telephone number of another individual (friend or relative) who might be reached in an emergency when the parent(s), guardian or legal custodian cannot be reached;
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