DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT
Facility Information

RANDOLPH AREA YOUNG MEN'S CHRISTIAN ASSOCIATION

002196707

(660) 263-3600

1000 KWIX RD
MOBERLY
MO  65270

RANDOLPH AREA YOUNG MEN'S CHRISTIAN ASSOCIATION

PO BOX 176
MOBERLY
MO  65270-0176

BOGGESS, CARL LEE

frontdesk@Randolphareaymca.com

Incorporated

ELLEN DONOHO

5 YEARS - 12 YEARS

49

GROUP HOME AND CENTER

 
Inspection Information

05/02/2018

2:30 PM

3:49 PM

UNANNOUNCED

COMPLIANCE MONITORING

2330625113


DocumentDocument-Date
APPLICATION 11/12/2015
EQUIPMENT LIST 11/12/2015
FIRE/SAFETY INSPECTION 12/08/2016
STAFF SHEET 11/12/2015
SANITATION INSPECTION 09/21/2015




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 4
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 20
StaffChildClass AgeNote
2 20 SCHOOL AGE

 
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 30-62.087 Fire Safety
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
Violation
 Provider Comments
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 Nikki Carter 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 for Emma Purdy.
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

Violation
Medical examination report form did not contain all required information as evidenced by statement of wellness.
Licensing Rule Reference
19 CSR 30-62.122 Medical Examination Reports (1) (D) states: The medical examination report form shall be supplied by the department or the facility may use its own form if it contains all the information on the department's form.
Correction Required
Medical reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-62.132 Admission Policies and Procedures
Compliance
19 CSR 30-62.142 Nighttime Care
Compliance
19 CSR 30-62.152 Hourly Care Facilities
Compliance
19 CSR 30-62.162 Overlap Care of Children
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
Compliance
RSMo 210.003 Immunizations of children required, when, exceptions--duties of administrator, report--notification of parents, when.
Compliance