MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
INDEPENDENCE 30 SCHOOL DISTRICT

Facility DVN
002432200

Phone
(816) 521-5483

Physical Address
2020 QUAIL DR
INDEPENDENCE
MO 64057-3429

Owner
INDEPENDENCE 30 SCHOOL DISTRICT

Mailing Address
201 N FOREST AVE
INDEPENDENCE
MO 64050-2513

Provider/Director
NICHOLSON, CHLOE MARIE

E-mail Address
YOUTH_DEVELOPMENT@ISDSCHOOLS.ORG

Incorporated

Child Care Specialist
MADELINE L DUMERCY

Age Range
5 YEARS - 11 YEARS

Capacity
60

Facility Type
SCHOOL AGE

Limitations
BEFORE AND AFTER SCHOOL CARE ONLY

Inspection Information

Date
08/02/2021

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2405628338

Document	Document-Date
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	01/13/2021
ANNUAL DECLARATION	01/13/2021
SAMPLE WEEKLY MENU	09/16/2013
SAMPLE FORMS	09/16/2013
POLICIES	09/16/2013
JOB RESPONSIBILITIES	09/16/2013
DISCIPLINE POLICIES	09/16/2013
DIRECTOR'S QUALIFICATIONS	09/17/2012
DIRECTOR'S JOB RESPONSIBILITIES	09/16/2013
DAILY SCHEDULE	09/16/2013
CHILD CARE PRACTICES	09/16/2013
APPLICATION	01/23/2019
EQUIPMENT LIST	05/17/2021
STAFF SHEET	04/23/2019

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.