DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

SALT FORK YOUNG MENS CHRISTIAN ASSOCIATION

002487081

(660) 886-3993

467 S ELLSWORTH AVE
MARSHALL
MO  65340-1916

SALT FORK YOUNG MEN'S CHRISTIAN ASSOCIATION

740 E. YERBY ST.
MARSHALL
MO  65340

ARMSTRONG, TYLER MORRIS

armstrong@saltforkymca.org

Incorporated

SUSAN MARIE DOUGLAS

5 YEARS - 12 YEARS

40

SCHOOL AGE

 
Inspection Information

10/07/2019

2:45 PM

4:01 PM

UNANNOUNCED

COMPLIANCE MONITORING

2366151465


DocumentDocument-Date
EQUIPMENT LIST 04/02/2018
STAFF SHEET 04/02/2018
APPLICATION 04/18/2018
ARTICLES OF INCORPORATION 08/04/2014
CERTIFICATE OF GOOD STANDING 05/03/2018
JOB RESPONSIBILITIES 08/04/2014
LINES OF ADMINISTRATIVE AUTHORITY 08/04/2014
DISASTER AND EMERGENCY PREPAREDNESS PLAN 08/04/2014
SAMPLE WEEKLY MENU 08/04/2014
CHILD CARE PRACTICES 08/04/2014
POLICIES 08/04/2014
DAILY SCHEDULE 08/04/2014
DISCIPLINE POLICIES 08/04/2014
DIRECTOR'S QUALIFICATIONS 08/16/2016
CERTIFICATE OF INCORPORATION 08/04/2014
DIRECTOR'S JOB RESPONSIBILITIES 10/16/2018
LOCAL FIRE DEPARTMENT NOTIFICATION 10/29/2018




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 4
Total Children 17
StaffChildClass AgeNote
4 17 SCHOOL AGE Staff Tyler Armstrong Kim Johnson Aliah Carter Julie Ash

 
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
Violation
 Provider Comments
Violation
The provider did not meet requirements for a criminal background check. The provider did not request the results of a criminal background check prior to employment or presence in the facility for the following staff: Tyler Armstrong, Ashley Dawson .
Licensing Rule Reference
19 CSR 30-62.102 Personnel (1) (L) states: The provider shall request the results of a criminal background check for child care staff members as required by 19 CSR 30-63.020 General Requirements.
Correction Required
Required requests of criminal background checks shall be on file.

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 Tyler Armstrong 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 Tyler Armstrong .
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
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
Violation
 Provider Comments
Violation
1 child(ren) records did not include telephone number of another individual who might be reached in an emergency.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (2) (C) states: Name, address and telephone number of another individual (friend or relative) who might be reached in an emergency when the parent(s), guardian or legal custodian cannot be reached;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

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