MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
YMCA-O'FALLON BRANCH-J. L. MUDD ELEMENTARY

Facility DVN
000172414

Phone
(636) 293-6380

Physical Address
610 PRINCE RUPPERT DR
O FALLON
MO 63366-1802

Owner
GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

Mailing Address
3451 PHEASANT MEADOW DR
O FALLON
MO 63368-7324

Provider/Director
PHILLIPS, KELLI

E-mail Address
KELLI.PHILLIPS@GWRYMCA.ORG

Incorporated
Incorporated

Child Care Specialist
DEBBIE ASHLOCK

Age Range
5 YEARS - 12 YEARS

Capacity
48

Facility Type
SCHOOL AGE

Limitations
BEFORE AND AFTER SCHOOL CARE ONLY

Inspection Information

Date
11/27/2018

Arrival Time
6:51 AM

Departure Time
8:43 AM

Notice
ANNOUNCED

Inspection Type
RENEWAL

Inspection ID
2345239828

Document	Document-Date
STAFF SHEET	11/27/2018
EQUIPMENT LIST	11/27/2018
APPLICATION	11/20/2018
DIRECTOR'S QUALIFICATIONS	02/05/2016
SAMPLE FORMS	05/15/1992
CERTIFICATE OF GOOD STANDING	11/04/2014
ARTICLES OF INCORPORATION	11/04/2014
CERTIFICATE OF INCORPORATION	11/04/2014
REGISTERING FICTITIOUS NAMES	11/04/2014
CHILD CARE PRACTICES	11/17/2014
DAILY SCHEDULE	11/17/2014
DISCIPLINE POLICIES	11/17/2014
JOB RESPONSIBILITIES	11/17/2014
LINES OF ADMINISTRATIVE AUTHORITY	11/17/2014
DIRECTOR'S JOB RESPONSIBILITIES	11/17/2014
SAMPLE WEEKLY MENU	11/17/2014
POLICIES	11/17/2014
OWNER/PROVIDER REFERENCES	11/17/2014
LOCAL FIRE DEPARTMENT NOTIFICATION	11/17/2014

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.

Attendance at Time of Inspection

Total Staff 2

Total Children 32

Staff	Child	Class Age	Note
2	32	SCHOOL AGE	with Belkis Palmero, Site Director and Kailey Barnes, Group Leader. Kelli Phillips, Approved Director was also present during the renewal.


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 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 Compliance
RSMo 210.003 Immunizations of children required, when, exceptions--duties of administrator, report--notification of parents, when. Compliance
RSMo 210.1080 Background checks required--definitions--procedures—ineligible for employment, when--exemption, when--emergency rules. Compliance