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

PENNOCK, DALLAS JORDAN

melissa.mueller@gwrymca.org

Incorporated

LEATRICE L DIXON

5 YEARS - 12 YEARS

48

SCHOOL AGE

BEFORE AND AFTER SCHOOL CARE ONLY
 
Inspection Information

05/11/2018

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2331156702


DocumentDocument-Date
STAFF SHEET 04/04/2018
SAMPLE WEEKLY MENU 08/30/2001
POLICIES 03/28/2009
LINES OF ADMINISTRATIVE AUTHORITY 06/21/1979
EQUIPMENT LIST 04/04/2018
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 04/04/2018
ARTICLES OF INCORPORATION 08/30/2001
APPLICATION 04/04/2018
DIRECTOR'S QUALIFICATIONS 01/24/2017
DISASTER AND EMERGENCY PREPAREDNESS PLAN 04/09/2018




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
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
Submit Documentation

Compliance Date
4/9/2018
19 CSR 30-62.092 Furniture, Equipment and Materials
Violation
 Provider Comments
Violation
The facility did not meet requirements for music and rhythm activities. The facility needed an additional 6 items in this category.
Licensing Rule Reference
19 CSR 30-62.092 Furniture, Equipment and Materials (2) (B) 2. F. states: Music and rhythm activities;
Correction Required
The facility shall provide appropriate equipment for children as required.

Correction Verification
Submit Documentation

Compliance Date
4/11/2018
19 CSR 30-62.102 Personnel
Violation
 Provider Comments
Violation
The requirements for documentation of 12 clock hours of annual training were not met as evidenced by there were insufficient training documents on file. The staff listed need the following documentation: Samantha Dobsch needs 1 clock hour for 2017, Ashleigh Krzyanowski needs .50 clock hrs for 2017.
Licensing Rule Reference
19 CSR 30-62.102 Personnel (3) (A) states: The center director, group day care home provider, all other caregivers, and those volunteers who are counted in staff/child ratios shall obtain at least twelve (12) clock hours of child-care related training during each year of employment in training which is approved by the department in: health, safety, nutrition, guidance and discipline, appropriate activities and learning experiences for children, positive communication and interaction with parents, planning and setting up an appropriate environment for children, professional and administrative practices, or other child related areas.
Correction Required
Required training hours shall be documented for each employee.

Correction Verification
Submit Documentation

Compliance Date
5/11/2018
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 Jacob Nelson.
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
4/9/2018
Violation
Medical examination report form did not contain all required information as evidenced by Sarah Edler's form did not contain all required information (stating she was or was not in good health).
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
4/19/2018
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
5/1/2018
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
The requirements for administering medication were not met as follows: medication was given to a child without written permission.
Licensing Rule Reference
19 CSR 30-62.192 Health Care (3) (B) states: All medication shall be given to a child only with the dated, written permission of the parent(s) stating the length of time medication may be given.
Correction Required
All medication shall be administered and recorded as required.

Correction Verification
Submit Documentation

Compliance Date
5/1/2018
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