DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

YMCA-O'FALLON BRANCH-MID RIVERS ELEMENTARY

000984350

(314) 443-6184

7479 MEXICO RD
ST PETERS
MO  63376

GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

3451 PHEASANT MEADOW DR
O FALLON
MO  63368-7324


kara.begemann@gwymca.org

Incorporated

KATHERINE D SIMS

5 YEARS - 12 YEARS

48

SCHOOL AGE

BEFORE AND AFTER SCHOOL CARE ONLY
 
Inspection Information

06/01/2021

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2401279256


DocumentDocument-Date
DIRECTOR'S QUALIFICATIONS 08/26/2014
CERTIFICATE OF INCORPORATION 06/21/1979
LINES OF ADMINISTRATIVE AUTHORITY 09/13/1994
JOB RESPONSIBILITIES 09/13/1988
SAMPLE FORMS 09/29/1997
CHILD CARE PRACTICES 09/29/1997
ARTICLES OF INCORPORATION 06/21/1979
POLICIES 09/29/1997
DAILY SCHEDULE 09/29/1997
REGISTERING FICTITIOUS NAMES 03/27/2013
CERTIFICATE OF GOOD STANDING 03/11/2015
SAMPLE WEEKLY MENU 09/29/1997
LOCAL FIRE DEPARTMENT NOTIFICATION 09/29/1997
DISCIPLINE POLICIES 09/29/1997
DIRECTOR'S JOB RESPONSIBILITIES 09/29/1997
DISASTER AND EMERGENCY PREPAREDNESS PLAN 03/02/2018
APPLICATION 03/05/2019
STAFF SHEET 03/20/2019
EQUIPMENT LIST 04/08/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 04/08/2021
ANNUAL DECLARATION 04/08/2021




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.

 
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
Violation
 Provider Comments
Violation
Requirements of facilities participation in disaster and emergency drills were not met as evidenced by the disaster or emergency drill was not held at least one time every three months.
Licensing Rule Reference
19 CSR 30-62.090 Disaster and Emergency Preparedness (3) (A) states: The licensee shall ensure that the facility has on file documentation that, at least every three (3) months, all staff and children at the facility have participated in a disaster or emergency drill based on the facility's disaster and emergency plan.
Correction Required
Fire, tornado, and other disaster drills shall be completed and recorded as required.

Correction Verification
Submit Documentation

Compliance Date
6/1/2021
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 form did not contain all required information as evidenced by Mackenzie Holtman and Kara Begemann's medical exams were not fully completed.
Licensing Rule Reference
19 CSR 30-62.122 Medical Examination Reports (1) (D) states: The medical examination report form shall be supplied by the department or the facility may use its own form if it contains all the information on the department's form.
Correction Required
Medical reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date
5/21/2021
Violation
Medical examination report did not include a completed Risk Assessment for Tuberculosis form for April Pentecost .
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
6/1/2021
Violation
Medical examination report was not on file for April Pentecost 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
6/1/2021
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
2 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
6/1/2021
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