DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

THE BOYS AND GIRLS CLUB OF POPLAR BLUFF

002373515

(573) 776-1690

1200 CAMP RD
POPLAR BLUFF
MO  63901

THE BOYS AND GIRLS CLUB OF POPLAR BLUFF

PO BOX 55
POPLAR BLUFF
MO  63902-0055

TIPTON, JEANNA DAWN

cpo@bgcpb.org


MELISSA JILL SMITH

5 YEARS - 7 YEARS

80

SCHOOL AGE

 
Inspection Information

07/12/2021

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2403846561


DocumentDocument-Date
ANNUAL DECLARATION 03/22/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 03/22/2021
EQUIPMENT LIST 03/22/2021
CERTIFICATE OF GOOD STANDING 03/22/2021
DAILY SCHEDULE 12/04/2012
POLICIES 12/04/2012
LINES OF ADMINISTRATIVE AUTHORITY 12/04/2012
DIRECTOR'S JOB RESPONSIBILITIES 12/04/2012
JOB RESPONSIBILITIES 12/04/2012
CHILD CARE PRACTICES 12/04/2012
SAMPLE FORMS 12/04/2012
DIRECTOR'S QUALIFICATIONS 04/18/2013
ARTICLES OF INCORPORATION 03/18/2015
CERTIFICATE OF INCORPORATION 03/18/2015
DISCIPLINE POLICIES 12/04/2012
SAMPLE WEEKLY MENU 11/20/2015
APPLICATION 02/22/2019
STAFF SHEET 03/06/2019




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
Violation
 Provider Comments
Violation
The Family Care Safety Registry check was not conducted for Emmaleigh Ivy and Mary Jett within thirty (30) days prior to the anniversary date.
Licensing Rule Reference
19 CSR 30-62.052 Annual Requirements (2) (C) states: The child care provider shall conduct a Family Care Safety Registry check for all child care staff members within thirty (30) days prior to the anniversary date as printed on the license.
Correction Required
Required Family Care Safety Registry checks shall be conducted for all child care staff member(s) within thirty (30) days prior to the anniversary date.

Correction Verification
Submit Documentation

Compliance Date
6/16/2021
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
Background screening information was not available for review for Sarah Holt, Kolbie Mansfield, Camryn Hardin, Raelyn Lansford, Mary Jett, Emmaleigh Ivy, and Josh Burkey.
Licensing Rule Reference
19 CSR 30-62.102 Personnel (1) (Q) states: Background screening information received by the provider shall be retained in the individual’s file in a confidential manner and available for review.
Correction Required
Background screening information shall be available and kept confidential.

Correction Verification
Submit Documentation

Compliance Date
7/12/2021
Violation
A facility orientation was not conducted for a caregiver(s) before being left alone with children. The following staff need a facility orientation: Camryn Hardin and Josh Burkey.
Licensing Rule Reference
19 CSR 30-62.102 Personnel (1) (K) . 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
Submit Documentation

Compliance Date
4/20/2021
Violation
A caregiver did not submit the Clock Hour Training Reassignment form to apply current year's clock hours for the prior year. The following staff need clock hours reassigned to the previous year: Kolbie Mansfield needs 4 hours, Raelyn Lansford needs 4 hours and Kaitlyn Hall needs 7 hours.
Licensing Rule Reference
19 CSR 30-62.102 Personnel (3) (K) states: Clock hours earned to complete the previous year’s requirements shall not be applied to the current year’s clock hour requirements. Caregivers shall submit the Clock Hour Training Credit Reassignment form to the OPEN Initiative to assign clock hours to the appropriate year. See Clock Hours Training Credit Reassignment form promulgated as of 2018 and incorporated by reference in this rule. As published by the Missouri Department of Health and Senior Services, PO Box 570, Jefferson City, MO 65102-0570 and available by the department at https://health.mo.gov/safety/childcare/forms.php. This rule does not incorporate any subsequent amendments or additions.
Correction Required
Caregivers shall submit the Clock Hour Training Credit Reassignment form to reassign current year's clock hours to the prior year.

Correction Verification
Submit Documentation

Compliance Date
4/20/2021
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
Violation
 Provider Comments
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
4/20/2021
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
4/20/2021
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
4/20/2021
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
4/20/2021
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
4/20/2021
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