DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

YMCA FOUR RIVERS BRANCH BEAUFORT ELEMENTARY

002369360

(314) 443-4357

3200 HWY 50
BEAUFORT
MO  63013

GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

400 GRAND AVE
WASHINGTON
MO  63090-1204

SOUDERS, NANCY

melissa.mueller@gwrymca.org

Incorporated

LEATRICE L DIXON

5 YEARS - 12 YEARS

20

SCHOOL AGE

 
Inspection Information

04/13/2018

2:10 PM

4:18 PM

ANNOUNCED

RENEWAL

2329332034


DocumentDocument-Date
CERTIFICATE OF INCORPORATION 08/20/2014
SAMPLE FORMS 08/19/2014
STAFF SHEET 04/11/2018
SAMPLE WEEKLY MENU 08/19/2014
POLICIES 08/19/2014
LOCAL FIRE DEPARTMENT NOTIFICATION 08/13/2014
JOB RESPONSIBILITIES 08/19/2014
DISCIPLINE POLICIES 08/19/2014
LINES OF ADMINISTRATIVE AUTHORITY 08/19/2014
CERTIFICATE OF GOOD STANDING 04/11/2018
ARTICLES OF INCORPORATION 08/19/2014
DAILY SCHEDULE 08/19/2014
CHILD CARE PRACTICES 08/19/2014
REGISTERING FICTITIOUS NAMES 08/06/2014
EQUIPMENT LIST 04/11/2018
APPLICATION 04/11/2018
DIRECTOR'S JOB RESPONSIBILITIES 10/27/2014
DIRECTOR'S QUALIFICATIONS 08/25/2015
DISASTER AND EMERGENCY PREPAREDNESS PLAN 04/13/2018




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 2
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 1
Total Children 5
StaffChildClass AgeNote
1 5 SCHOOL AGE Nancy Souder with children ages 5 to 12 years

 
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
Violation
 Provider Comments
Violation
The facility has not developed, implemented or maintained policies and procedures for responding to a disaster emergency.
Licensing Rule Reference
19 CSR 30-62.090 Disaster and Emergency Preparedness (1) (A) states: The facility shall develop, implement, and maintain policies and procedures for responding to a disaster emergency, including a written plan for:
Correction Required
Facility must have plan on file as required.

Correction Verification
Corrected on Site

Compliance Date
4/13/2018
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
Violation
 Provider Comments
Violation
Medical examination report did not include a completed Risk Assessment for Tuberculosis form for Nancy Souders TB Risk Assessment did not have a medical person's signature;.
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
Compliance
RSMo 210.003 Immunizations of children required, when, exceptions--duties of administrator, report--notification of parents, when.
Compliance