DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

YMCA-FOUR RIVERS BRANCH-MARTHASVILLE ELEMENTARY

000978858

(636) 231-2650

800 E MAIN
MARTHASVILLE
MO  63357

GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

400 GRAND AVE
WASHINGTON
MO  63090-1204

PENNOCK, DALLAS JORDAN

dallas.pennoch@gwrymca.org

Incorporated

JOY LYNN NICHOLS

5 YEARS - 12 YEARS

32

SCHOOL AGE

 
Inspection Information

11/28/2017

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2318662798


DocumentDocument-Date
STAFF SHEET 10/04/2017
EQUIPMENT LIST 10/04/2017
APPLICATION 09/01/2017
CERTIFICATE OF GOOD STANDING 12/14/2015
JOB RESPONSIBILITIES 11/09/2015
LINES OF ADMINISTRATIVE AUTHORITY 12/14/2015
SAMPLE FORMS 11/09/2015
SAMPLE WEEKLY MENU 11/09/2015
DAILY SCHEDULE 11/09/2015
DIRECTOR'S QUALIFICATIONS 12/01/2015
POLICIES 12/01/2015
REGISTERING FICTITIOUS NAMES 12/14/2015
DISCIPLINE POLICIES 12/01/2015
ARTICLES OF INCORPORATION 12/01/2015
DIRECTOR'S JOB RESPONSIBILITIES 12/01/2015




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
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 Reviews were missing/out of date for the following owner(s), board president or chairperson, or center director or group day care home provider: Madelyn Woods.
Licensing Rule Reference
19 CSR 30-62.052 License Renewal (2) states: The facility owner(s), board president or chairperson, and the center director or group day care home provider shall be screened for child abuse/neglect prior to renewal of the license.
Correction Required
Required requests/results of current background checks shall be on file.

Correction Verification
Submit Documentation

Compliance Date
10/24/2017
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 Reviews were missing/out of date for the following owner(s), board president or chairperson, center director or group day care home provider, person(s) employed or volunteer(s) counted in staff/child ratio: Madelyn Woods.
Licensing Rule Reference
19 CSR 30-62.052 License Renewal (3) states: After the child care provider applies for renewal of the license, the provider shall request the results of a criminal record review from the Missouri State Highway Patrol for the child care provider, the owner(s), board president or chairperson, the center director or group day care home provider, all persons employed by the child care provider, and all volunteers counted in staff/child ratios. 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
10/24/2017
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
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
One 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
10/18/2017
Violation
One 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
10/18/2017
RSMo 210.003 Immunizations of children required, when, exceptions--duties of administrator, report--notification of parents, when.
Compliance