DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

TRI-STATE FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION

002056546

(417) 451-8610

1120 CARL SWEENEY RD
NEOSHO
MO  64850-7743

TRI-STATE FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION

4701 CHOUTEAU AVE
NEOSHO
MO  64850-9123

CLONTS, EMALEIGH A

tina@tristatefamilyymca.org

Incorporated

PENNY KREITZER

5 YEARS - 12 YEARS

60

SCHOOL AGE

AFTER SCHOOL CARE ONLY
 
Inspection Information

03/29/2021

4:10 PM

4:52 PM

UNANNOUNCED

COMPLIANCE MONITORING

2396372945


DocumentDocument-Date
LINES OF ADMINISTRATIVE AUTHORITY 08/08/2007
DAILY SCHEDULE 08/08/2007
SAMPLE WEEKLY MENU 08/08/2007
APPLICATION 01/23/2019
CERTIFICATE OF GOOD STANDING 04/10/2015
EQUIPMENT LIST 04/12/2019
STAFF SHEET 04/12/2019
DISASTER AND EMERGENCY PREPAREDNESS PLAN 01/07/2020




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 2
Total Children 25
StaffChildClass AgeNote
2 25 SCHOOL AGE Justin McGuirk and Allison Hunt Caregivers

 
19 CSR 30-62.032 Organization and Administration
Compliance
19 CSR 30-62.042 Licensing Process
Compliance
19 CSR 30-62.052 Annual Requirements
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
Violation
 Provider Comments
Violation
Medical examination report did not include a completed Risk Assessment for Tuberculosis form for Grace Werner.
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
Not Observed
19 CSR 30-62.222 Records and Reports
Violation
 Provider Comments
Violation
4 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
1 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
Records were not available for inspection by the department upon request as evidenced by there was no record on file for Allison Hunt, Caregiver.
Licensing Rule Reference
19 CSR 30-62.222 Records and Reports (11) states: All records shall be available in the facility for inspection by the department upon request.
Correction Required
Records shall be available at the facility for inspection.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-63.020 General Requirements
Compliance
19 CSR 30-63.040 Background Screening Findings
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