DHSS MO
MISSOURI DEPARTMENT OF HEALTH & SENIOR SERVICES

SECTION FOR CHILD CARE REGULATION

SCHOOL AGE INSPECTION REPORT
Facility Information

THE BOYS AND GIRLS CLUB OF POPLAR BLUFF

002373515

(573) 776-1690

1200 CAMP RD
POPLAR BLUFF
MO  63901

THE BOYS & GIRLS CLUB OF POPLAR BLUFF

PO BOX 55
POPLAR BLUFF
MO  63902-0055

TIPTON, JEANNA DAWN

LITTLES, RONALD B

lesley@bgcpb.org



MELISSA JILL SMITH

5 YEARS - 7 YEARS

100

SCHOOL AGE

 
Inspection Information

10/12/2017

3:50 PM

5:26 PM

UNANNOUNCED

COMPLIANCE MONITORING

2315409663


DocumentDocument-Date
SAMPLE WEEKLY MENU 11/20/2015
APPLICATION 03/06/2017
DAILY SCHEDULE 12/04/2012
POLICIES 12/04/2012
LINES OF ADMINISTRATIVE AUTHORITY 12/04/2012
DIRECTOR'S JOB RESPONSIBILITIES 12/04/2012
JOB RESPONSIBILITIES 12/04/2012
CHILD CARE PRACTICES 12/04/2012
SAMPLE FORMS 12/04/2012
DIRECTOR'S QUALIFICATIONS 04/18/2013
EQUIPMENT LIST 03/06/2017
STAFF SHEET 03/06/2017
ARTICLES OF INCORPORATION 03/18/2015
CERTIFICATE OF INCORPORATION 03/18/2015
DISCIPLINE POLICIES 12/04/2012




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 8
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 5
Total Children 43
StaffChildClass AgeNote
2 10 SCHOOL AGE Staff: Matt Smith and Mrs. Tipton
2 16 SCHOOL AGE Staff: Elisha Stout and Jessica Billington Also present in this room, but not counting in staff/child ratio: Mrs. DeWitt (teacher at elementary school)
1 17 SCHOOL AGE Staff: Skye Rush; also present, but not counting in staff/child ratio: Mrs. Hagar (school employee)

 
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 30-62.090 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
Violation
 Provider Comments
Violation
Caregiver-child ratio requirements were not met as evidenced by 17 children ages 5-7 years were cared for by 1 caregiver(s).
Licensing Rule Reference
19 CSR 30-62.112 Staff/Child Ratios (1) (D) states: Ages Five (5) and Up. Groups composed solely of five (5)-year olds and older shall have no less than one (1) adult to every sixteen (16) children;
Correction Required
Correct caregiver-child ratios shall be maintained.

Correction Verification
Return Inspection

Compliance Date

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
Return Inspection

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
Violation
 Provider Comments
Violation
Requirements for immunization reports on file were not met as evidenced by required immunizations verifying the type of vaccine and the month, day and year of administration was not on file for 1 child(ren).
Licensing Rule Reference
19 CSR 30-62.192 Health Care (4) (A) states: No child shall be permitted to enroll in or attend any day care facility caring for ten (10) or more children unless the child has been immunized adequately against vaccine preventable childhood illnesses specified by the department in accordance with recommendations of the Immunization Practices Advisory Committee (ACIP). The parent or guardian of the child shall provide satisfactory evidence of the required immunizations. Satisfactory evidence means a statement, certificate or record from a physician or other recognized health facility or personnel, stating that the required immunizations have been given to the child and verifying the type of vaccine and the month, day and year of administration.
Correction Required
Child immunization requirements shall be on file as required.

Correction Verification
Return Inspection

Compliance Date

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
The provider failed to maintain accurate records to meet administrative requirements as evidenced by the facility uses an enrollment form specific to the Boys & Girls Club. The form does not have all required information.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (1) states: The child care provider shall maintain accurate records to meet administrative requirements and to ensure knowledge of the individual needs of children and their families.
Correction Required
Accurate records shall be maintained.

Correction Verification
Return Inspection

Compliance Date

Violation
5 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
Return Inspection

Compliance Date

Violation
10 child(ren) records did not include 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
Return Inspection

Compliance Date

Violation
5 child(ren) records did not include telephone number 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
Return Inspection

Compliance Date

RSMo 210.003 Immunizations of children required, when, exceptions--duties of administrator, report--notification of parents, when.
Violation
 Provider Comments
Violation
Parent and/or guardian was not notified upon request of whether there are children currently enrolled in or attending the facility for whom an immunization exemption has been filed.
Licensing Rule Reference
RSMo 210.003 Immunizations of children required, when, exceptions--duties of administrator, report--notification of parents, when. 7. states: All public, private, and parochial day care centers, preschools, and nursery schools shall notify the parent or guardian of each child at the time of initial enrollment in or attendance at the facility that the parent or guardian may request notice of whether there are children currently enrolled in or attending the facility for whom an immunization exemption has been filed. Beginning December 1, 2015, all public, private, and parochial day care centers, preschools, and nursery schools shall notify the parent or guardian of each child currently enrolled in or attending the facility that the parent or guardian may request notice of whether there are children currently enrolled in or attending the facility for whom an immunization exemption has been filed. Any public, private, or parochial day care center, preschool, or nursery school shall notify the parent or guardian of a child enrolled in or attending the facility, upon request, of whether there are children currently enrolled in or attending the facility for whom an immunization exemption has been filed.
Correction Required
Parent and/or guardian shall be notified upon request of whether there are children currently enrolled in or attending the facility for whom an immunization exemption has been filed.

Correction Verification
Return Inspection

Compliance Date