MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
JEFFERSON CITY AREA YOUNG MEN'S CHRISTIAN ASSOCIATION

Facility DVN
000189335

Phone
(573) 761-3196

Physical Address
285 S SUMMIT DR
HOLTS SUMMIT
MO 65043

Owner
JEFFERSON CITY AREA YOUNG MEN'S CHRISTIAN ASSOCIATION

Mailing Address
PO BOX 104176
JEFFERSON CITY
MO 65110

Provider/Director
GREEN, JORDAN ROBERT

E-mail Address
JKEVER@JCYMCA.ORG

Incorporated
Incorporated

Child Care Specialist
JIM PARSLEY

Age Range
5 YEARS - 12 YEARS

Capacity
60

Facility Type
SCHOOL AGE

Limitations

Inspection Information

Date
10/01/2019

Arrival Time
2:50 PM

Departure Time
3:38 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2365728139

Document	Document-Date
DIRECTOR'S QUALIFICATIONS	12/13/2012
DISCIPLINE POLICIES	08/05/1985
DIRECTOR'S JOB RESPONSIBILITIES	08/26/1993
JOB RESPONSIBILITIES	08/05/1985
LINES OF ADMINISTRATIVE AUTHORITY	08/05/1985
CHILD CARE PRACTICES	08/05/1985
DAILY SCHEDULE	08/05/1985
POLICIES	08/05/1985
SAMPLE FORMS	08/10/1984
SAMPLE WEEKLY MENU	08/05/1985
CERTIFICATE OF INCORPORATION	07/19/1984
CERTIFICATE OF GOOD STANDING	03/12/2013
STAFF SHEET	04/03/2019
EQUIPMENT LIST	04/08/2019
APPLICATION	04/03/2019

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 6

Total Children 71

Staff	Child	Class Age	Note
6	71	SCHOOL AGE	There were 71 school age children ages 5 through 12 years being supervised by: (1) Josh Furgeson (2) Cole Campbell (3) Jen Gamble (4) Emma Haechen (5) Matthew West (6) Noah Jahr


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 Not Observed
19 CSR 30-62.222 Records and Reports Compliance
19 CSR 30-63.040 Background Screening Findings 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
RSMo 210.211. License required - exceptions - written notice of licensure status, when. Compliance