MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
YMCA OF SOUTHEAST MISSOURI SOUTHEAST ELEMENTARY

Facility DVN
002267256

Phone
(573) 419-9736

Physical Address
2300 ABLES RD
SIKESTON
MO 63801

Owner
YMCA OF SOUTHEAST MISSOURI

Mailing Address
511 TAYLOR ST
SIKESTON
MO 63801

Provider/Director
BURNS, AMY LYNN

E-mail Address
CLIMBAUGH@YMCASEMO.NET

Incorporated
Incorporated

Child Care Specialist
MELISSA JILL SMITH

Age Range
5 YEARS - 12 YEARS

Capacity
30

Facility Type
SCHOOL AGE

Limitations

Inspection Information

Date
02/20/2020

Arrival Time
4:10 PM

Departure Time
5:36 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2376370116

Document	Document-Date
APPLICATION	12/13/2018
EQUIPMENT LIST	01/14/2019
STAFF SHEET	01/14/2019
CERTIFICATE OF GOOD STANDING	01/08/2015
ARTICLES OF INCORPORATION	12/17/2010
CERTIFICATE OF INCORPORATION	12/17/2010
CHILD CARE PRACTICES	12/17/2010
DAILY SCHEDULE	12/17/2010
DISCIPLINE POLICIES	12/17/2010
JOB RESPONSIBILITIES	12/17/2010
LINES OF ADMINISTRATIVE AUTHORITY	12/17/2010
POLICIES	12/17/2010
SAMPLE WEEKLY MENU	02/02/2015
REGISTERING FICTITIOUS NAMES	01/27/2017
DIRECTOR'S JOB RESPONSIBILITIES	10/12/2010
DIRECTOR'S QUALIFICATIONS	09/20/2018

Inspection determined facility to be in compliance with licensing rules.

Open Violations: 33

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 1

Total Children 11

Staff	Child	Class Age	Note
1	11	SCHOOL AGE	Caregiver: Shakyra Jones

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 facility did not meet requirements for a criminal background check. Results were not on file for the following staff member(s): Shakyra Jones. Licensing Rule Reference 19 CSR 30-62.102 Personnel (1) (M) states: Child care staff members shall have qualifying background screening results on file as required by 19 CSR 30-63.020 General Requirements. Correction Required Required results of criminal background checks shall be on file. Correction Verification Submit Documentation Compliance Date
Violation The center director was not certificated by the department. Licensing Rule Reference 19 CSR 30-62.102 Personnel (2) (B) 1. F. states: Official verification of the education and experience of the group day care home provider or center director shall be on file with the department prior to beginning employment. Correction Required The director of the facility shall be certificated by the department. Correction Verification Submit Documentation Compliance Date 12/13/2019
Violation The Day care center director was not certified by the Section for Child Care Regulation as evidence by not viewing the approved Director paperwork on file. Licensing Rule Reference 19 CSR 30-62.102 Personnel (2) (B) 3. B. states: Day care center directors employed after the effective date of these rules shall meet the following education or experience requirements, or both, as determined by the licensed capacity of the center in which they are to serve: Correction Required The director of the facility shall be certified by the Section for Child Care Regulation. Correction Verification Submit Documentation Compliance Date 12/13/2019
Violation A caregiver did not obtain one clock hour of training for each month of employment. The staff listed need the following information: Shakyra Jones needs 2 clock hours of training for 2019. Licensing Rule Reference 19 CSR 30-62.102 Personnel (3) (C) states: Caregivers who were employed after the first of the year shall obtain one (1) clock of hour training for each one (1) month of employment, regardless of the date employment began. Correction Required Required training hours shall be documented for each employee. 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 A school-age child's health report was not on file at the time of enrollment as evidenced by one child was missing the parent signature on the form. Licensing Rule Reference 19 CSR 30-62.122 Medical Examination Reports (2) (D) states: The parent(s) of a school-age child shall provide a report at the time of enrollment indicating the child's health history, any current health problems, and any restrictions necessary for the child's care. Correction Required Child medical requirements shall be completed and on file as required. Correction Verification Submit Documentation Compliance Date

19 CSR 30-62.132 Admission Policies and Procedures

Violation

	Provider Comments
Violation The provider did not have parental acknowledgement on file indicating the parent has been informed that Licensing Rules for Group Day Care Homes and Child Day Care Centers in Missouri are available for review. Licensing Rule Reference 19 CSR 30-62.132 Admission Policies and Procedures (8) (E) 8. B. states: They have been informed that the Licensing Rules for Group Day Care Homes and Child Day Care Centers in Missouri are available in the facility for their review; Correction Required Child enrollment information shall be completed and on file as required. Correction Verification Submit Documentation Compliance Date
Violation The provider did not have parental acknowledgement on file indicating the parent received a copy of the provider's policies. Licensing Rule Reference 19 CSR 30-62.132 Admission Policies and Procedures (8) (E) 8. A. states: They have received a copy of the provider's policies pertaining to the admission, care and discharge of children; Correction Required Child enrollment information shall be completed and on file as required. Correction Verification Submit Documentation Compliance Date
Violation Written permission was not on file for transportation to and from school. Licensing Rule Reference 19 CSR 30-62.132 Admission Policies and Procedures (8) (E) 6. states: Permission for field trips, transportation to and from school and other transportation; Correction Required Written permission for field and transportation shall be on file as required. Correction Verification Submit Documentation Compliance Date
Violation Written permission was not on file for field trips. Licensing Rule Reference 19 CSR 30-62.132 Admission Policies and Procedures (8) (E) 6. states: Permission for field trips, transportation to and from school and other transportation; Correction Required Written permission for field and transportation shall be on file as required. Correction Verification Submit Documentation Compliance Date
Violation The facility did not meet requirements for child enrollment and health information as evidenced by one child did not have a completed enrollment form. Licensing Rule Reference 19 CSR 30-62.132 Admission Policies and Procedures (8) (E) 4. states: Instructions for action to be taken if the parent(s) or physician designated by the parent(s) cannot be reached in an emergency and permission for emergency medical care; Correction Required Child enrollment information shall be completed and on file as required. Correction Verification Submit Documentation Compliance Date
Violation The facility did not meet requirements for child enrollment and health information as evidenced by one child did not have a completed enrollment form. Licensing Rule Reference 19 CSR 30-62.132 Admission Policies and Procedures (8) (E) 2. states: Information regarding a child's personal development, behavior patterns, habits and individual needs; Correction Required Child enrollment information shall be completed and on file as required. Correction Verification Submit Documentation Compliance Date
Violation The provider did not have parental acknowledgement on file indicating the parent and provider have agreed on a plan for continuing communication. Licensing Rule Reference 19 CSR 30-62.132 Admission Policies and Procedures (8) (E) 8. C. states: They and the provider have agreed on a plan for continuing communication regarding the child's development, behavior and individual needs; Correction Required Child enrollment information shall be completed and on file as required. Correction Verification Submit Documentation Compliance Date
Violation The provider did not have parental acknowledgement on file indicating the parent understands and agrees that the child may not be accepted for care when ill. Licensing Rule Reference 19 CSR 30-62.132 Admission Policies and Procedures (8) (E) 8. D. states: They understand and agree that the child may not be accepted for care when ill. Correction Required Child enrollment information shall be completed and on file as required. Correction Verification Submit Documentation Compliance Date
Violation The facility did not meet requirements for child enrollment and health information on file as evidenced by child(s) file(s) did not have the parental acknowledgement they have been notified that they may request whether there are children for whom an immunization exemption has been filed for currently enrolled in or attending the facility. Licensing Rule Reference 19 CSR 30-62.132 Admission Policies and Procedures (8) (E) 8. F. states: They have been notified that they may request notice at initial enrollment in or attendance at the facility or upon request of whether there are children for whom an immunization exemption has been filed currently enrolled in or attending the facility. Correction Required Child enrollment information shall be completed and on file as requested. Correction Verification Submit Documentation Compliance Date

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 Requirements for immunization reports on file were not met as evidenced by for all enrolled school age children immunization record(s) was/were not on file . Licensing Rule Reference 19 CSR 30-62.192 Health Care (4) (A) states: No child shall be permitted to enroll in or attend any day care facility caring for ten (10) or more children unless the child has been immunized adequately against vaccine preventable childhood illnesses specified by the department in accordance with recommendations of the Immunization Practices Advisory Committee (ACIP). The parent or guardian of the child shall provide satisfactory evidence of the required immunizations. Satisfactory evidence means a statement, certificate or record from a physician or other recognized health facility or personnel, stating that the required immunizations have been given to the child and verifying the type of vaccine and the month, day and year of administration. Correction Required Child immunization requirements shall be on file as required. Correction Verification Submit Documentation Compliance Date 2/20/2020

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 One child(ren) records did not include child's birth date. Licensing Rule Reference 19 CSR 30-62.222 Records and Reports (2) (A) states: The child's full name, address, birth-date and the date care begins and ends; Correction Required Child enrollment information shall be completed and on file as required. Correction Verification Submit Documentation Compliance Date
Violation The provider failed to maintain accurate records to meet administrative requirements as evidenced by one child was missing parent signature on the back of their enrollment form. Licensing Rule Reference 19 CSR 30-62.222 Records and Reports (1) states: The child care provider shall maintain accurate records to meet administrative requirements and to ensure knowledge of the individual needs of children and their families. Correction Required Accurate records shall be maintained. Correction Verification Submit Documentation Compliance Date
Violation One child(ren) records did not include child's address. Licensing Rule Reference 19 CSR 30-62.222 Records and Reports (2) (A) states: The child's full name, address, birth-date and the date care begins and ends; Correction Required Child enrollment information shall be completed and on file as required. Correction Verification Submit Documentation Compliance Date
Violation One child(ren) records did not include child's full name. Licensing Rule Reference 19 CSR 30-62.222 Records and Reports (2) (A) states: The child's full name, address, birth-date and the date care begins and ends; Correction Required Child enrollment information shall be completed and on file as required. Correction Verification Submit Documentation Compliance Date
Violation One child(ren) records did not include date care begins and ends. Licensing Rule Reference 19 CSR 30-62.222 Records and Reports (2) (A) states: The child's full name, address, birth-date and the date care begins and ends; Correction Required Child enrollment information shall be completed and on file as required. Correction Verification Submit Documentation Compliance Date
Violation One child(ren) records did not include home telephone number of parent(s), guardian or legal custodian. Licensing Rule Reference 19 CSR 30-62.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers; Correction Required Child enrollment information shall be completed and on file as required. Correction Verification Submit Documentation Compliance Date
Violation One child(ren) records did not include work schedule of parent(s), guardian or legal custodian. Licensing Rule Reference 19 CSR 30-62.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers; Correction Required Child enrollment information shall be completed and on file as required. Correction Verification Submit Documentation Compliance Date
Violation One child(ren) records did not include employers' address of parent(s), guardian or legal custodian. Licensing Rule Reference 19 CSR 30-62.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers; Correction Required Child enrollment information shall be completed and on file as required. Correction Verification Submit Documentation Compliance Date
Violation One child(ren) records did not include employers' name of parent(s), guardian or legal custodian. Licensing Rule Reference 19 CSR 30-62.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers; Correction Required Child enrollment information shall be completed and on file as required. Correction Verification Submit Documentation Compliance Date
Violation One child(ren) records did not include home address of parent(s), guardian or legal custodian. Licensing Rule Reference 19 CSR 30-62.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers; Correction Required Child enrollment information shall be completed and on file as required. Correction Verification Submit Documentation Compliance Date
Violation One child(ren) records did not include full name of parent(s), guardian or legal custodian. Licensing Rule Reference 19 CSR 30-62.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers; Correction Required Child enrollment information shall be completed and on file as required. Correction Verification Submit Documentation Compliance Date
Violation One child(ren) records did not include work telephone number of parent(s), guardian or legal custodian. Licensing Rule Reference 19 CSR 30-62.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers; Correction Required Child enrollment information shall be completed and on file as required. Correction Verification Submit Documentation Compliance Date
Violation One child(ren) records did not include name of family physician or hospital. Licensing Rule Reference 19 CSR 30-62.222 Records and Reports (2) (D) states: Name and phone number of the family physician, hospital, or both, to be used in an emergency; Correction Required Child enrollment information shall be completed and on file as required. Correction Verification Submit Documentation Compliance Date
Violation One child(ren) records did not include telephone number of family physician or hospital. Licensing Rule Reference 19 CSR 30-62.222 Records and Reports (2) (D) states: Name and phone number of the family physician, hospital, or both, to be used in an emergency; Correction Required Child enrollment information shall be completed and on file as required. Correction Verification Submit Documentation Compliance Date
Violation One child(ren) records did not include name of individual authorized to take the child from the facility. Licensing Rule Reference 19 CSR 30-62.222 Records and Reports (2) (E) states: Name of the individual(s) authorized to take the child from the facility; Correction Required Child enrollment information shall be completed and on file as required. Correction Verification Submit Documentation Compliance Date
Violation One child(ren) records did not include field trip and transportation authorization. Licensing Rule Reference 19 CSR 30-62.222 Records and Reports (2) (F) states: Field trip and transportation authorization. Correction Required Child enrollment information shall be completed and on file as required. Correction Verification Submit Documentation Compliance Date
Violation An individual file was not kept for one child(ren). Licensing Rule Reference 19 CSR 30-62.222 Records and Reports (2) . states: An individual file shall be kept to identify each child and enable the provider to communicate with the parent(s), guardian or legal custodian of the child in an emergency. Correction Required Accurate records shall be maintained. Correction Verification Submit Documentation Compliance Date
Violation A written record of fire and disaster drills not available at the facility. Licensing Rule Reference 19 CSR 30-62.222 Records and Reports (8) states: The provider shall maintain a written record at the facility for fire and disaster drills. Correction Required Fire & disaster drills shall be recorded and kept on file. Correction Verification Submit Documentation Compliance Date
Violation One 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
Violation One child(ren) records did not include address 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
Violation One child(ren) records did not include name 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 210.115. Reports of abuse, neglect, and under age eighteen deaths — persons required to report — supervisors and administrators not to impede reporting — deaths required to be reported to the division or child fatality review panel, when — report made to another state, when. —

Compliance

RSMo 210.211. License required - exceptions - written notice of licensure status, when.

Compliance