MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
YMCA-FOUR RIVERS BRANCH-WASHINGTON WEST ELEMENTARY

Facility DVN
001178345

Phone
(636) 239-5704

Physical Address
1570 W FIFTH ST
WASHINGTON
MO 63090

Owner
GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

Mailing Address
400 GRAND AVE
WASHINGTON
MO 63090-1204

Provider/Director
SPRECKELMEYER, JOANN M

E-mail Address
melissa.mueller@gwrymca.org

Incorporated
Incorporated

Child Care Specialist
LEATRICE L DIXON

Age Range
5 YEARS - 12 YEARS

Capacity
48

Facility Type
SCHOOL AGE

Limitations
BEFORE AND AFTER SCHOOL CARE ONLY

Inspection Information

Date
05/06/2021

Arrival Time
10:55 AM

Departure Time
11:26 AM

Notice
ANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2399495912

Document	Document-Date
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	03/09/2021
ANNUAL DECLARATION	03/09/2021
DIRECTOR'S JOB RESPONSIBILITIES	08/13/1998
DISCIPLINE POLICIES	06/22/2000
LINES OF ADMINISTRATIVE AUTHORITY	02/11/2008
JOB RESPONSIBILITIES	08/13/1998
LOCAL FIRE DEPARTMENT NOTIFICATION	02/28/2008
CHILD CARE PRACTICES	08/13/1998
SAMPLE WEEKLY MENU	01/23/2006
DAILY SCHEDULE	01/23/2006
POLICIES	06/22/2000
CERTIFICATE OF INCORPORATION	08/13/1998
ARTICLES OF INCORPORATION	08/13/1998
DIRECTOR'S QUALIFICATIONS	05/06/2021
EQUIPMENT LIST	05/06/2021
STAFF SHEET	02/07/2020
APPLICATION	01/30/2020
CERTIFICATE OF GOOD STANDING	03/09/2021
DISASTER AND EMERGENCY PREPAREDNESS PLAN	08/15/2018
REGISTERING FICTITIOUS NAMES	03/09/2021

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 1

Staff	Child	Class Age	Note
1	0	NO CHILDREN IN ATTENDANCE	Melissa Mueller, program director with no children (facility is inactive)


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 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 Compliance
19 CSR 30-62.222 Records and Reports Compliance
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