DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

HERBERT HOOVER BOYS AND GIRLS CLUB - ADAMS PARK UNIT

002068711

(314) 633-7900

4317 VISTA AVE
ST LOUIS
MO  63110

THE HERBERT HOOVER BOYS AND GIRLS CLUB OF ST. LOUIS, INC.



 

JEFFERIES, MARLA

KEISHA@BGCSTL.ORG

Incorporated

KATHERINE D SIMS

5 YEARS - 16 YEARS

256

SCHOOL AGE

 
Inspection Information

11/18/2020

2:05 PM

2:27 PM

UNANNOUNCED

REINSPECTION

2388186506


DocumentDocument-Date
SAMPLE WEEKLY MENU 02/28/2008
LINES OF ADMINISTRATIVE AUTHORITY 11/01/2007
JOB RESPONSIBILITIES 02/28/2008
DISCIPLINE POLICIES 02/28/2008
DIRECTOR'S QUALIFICATIONS 07/02/2012
DIRECTOR'S JOB RESPONSIBILITIES 02/28/2012
DAILY SCHEDULE 02/28/2008
CHILD CARE PRACTICES 02/28/2008
SAMPLE FORMS 02/28/2008
POLICIES 02/28/2008
CERTIFICATE OF INCORPORATION 11/01/2007
ARTICLES OF INCORPORATION 11/01/2007
CERTIFICATE OF GOOD STANDING 05/18/2018
EQUIPMENT LIST 08/21/2020
STAFF SHEET 08/21/2020
REGISTERING FICTITIOUS NAMES 07/02/2012
APPLICATION 05/04/2020
DISASTER AND EMERGENCY PREPAREDNESS PLAN 05/25/2018




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.
Attendance at Time of Inspection
Total Staff 5
Total Children 18
StaffChildClass AgeNote
3 0 NO CHILDREN IN ATTENDANCE Marla Jefferies, Natalie Wathen, and Henry Johnson present with no children in attednace
1 8 SCHOOL AGE Terri Bascom present with 8 children, ages 10-16yrs old
1 10 SCHOOL AGE Ben Fulner present with 10 children, ages 7-9yrs old

 
19 CSR 30-62.032 Organization and Administration
Not Observed
19 CSR 30-62.042 Initial Licensing Information
Not Observed
19 CSR 30-62.052 Annual Requirements
Not Observed
19 CSR 30-62.082 Physical Requirements of Group Day Care Homes and Day Care Centers
Not Observed
19 CSR 30-62.090 Disaster and Emergency Preparedness
Not Observed
19 CSR 30-62.092 Furniture, Equipment and Materials
Not Observed
19 CSR 30-62.102 Personnel
Violation
 Provider Comments
Violation
A facility orientation was not documented and available for review for all caregivers. The following staff need documentation of a facility orientation: Blake Morehouse and Donte Hopkins.
Licensing Rule Reference
19 CSR 30-62.102 Personnel (1) (J) . states: The child care provider shall ensure that within seven (7) days of employment or volunteering and before being left alone with children that caregivers receive a facility orientation. The child care provider shall ensure that documentation verifying completion of the facility orientation is maintained and on file for review by the department for each caregiver. The facility orientation shall include:
Correction Required
The facility shall ensure that a facility orientation occurs within 7 days and documentation verifying completion is maintained and on file for review by the department for each caregiver.

Correction Verification
Return Inspection

Compliance Date
11/18/2020
Violation
The facility did not meet requirements for a criminal background check. Results were not on file for the following staff member(s): Blake Morehouse and Donte Hopkins.
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
Return Inspection

Compliance Date
11/18/2020
19 CSR 30-62.112 Staff/Child Ratios
Not Observed
19 CSR 30-62.122 Medical Examination Reports
Violation
 Provider Comments
Violation
Medical examination report was not on file for Blake Morehouse and Donte Hopkins 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
Return Inspection

Compliance Date
11/18/2020
Violation
Medical examination report did not include a completed Risk Assessment for Tuberculosis form for Blake Morehouse and Donte Hopkins.
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
Return Inspection

Compliance Date
11/18/2020
19 CSR 30-62.132 Admission Policies and Procedures
Not Observed
19 CSR 30-62.172 Emergency School Closings
Not Observed
19 CSR 30-62.182 Child Care Program
Not Observed
19 CSR 30-62.192 Health Care
Not Observed
19 CSR 30-62.202 Nutrition and Food Service
Not Observed
19 CSR 30-62.212 Transportation and Field Trips
Not Observed
19 CSR 30-62.222 Records and Reports
Violation
 Provider Comments
Violation
2 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
Return Inspection

Compliance Date
11/18/2020
19 CSR 30-63.020 General Requirements
Not Observed
19 CSR 30-63.040 Background Screening Findings
Not Observed
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. —
Not Observed
RSMo 210.211.  License required - exceptions - written notice of licensure status, when.
Not Observed