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


SAMINA C HISE

5 YEARS - 7 YEARS

80

SCHOOL AGE

 
Inspection Information

09/21/2021

4:01 PM

4:56 PM

UNANNOUNCED

COMPLIANCE MONITORING

2408947796


DocumentDocument-Date
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
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




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 3
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 7
Total Children 58
StaffChildClass AgeNote
1 0 NO CHILDREN IN ATTENDANCE Site director Katlyn Hall with no children present.
2 17 SCHOOL AGE Caregiver Camryn Hardin and teacher Heather Swift with seventeen school aged children between the ages 5-6 years old.
2 20 SCHOOL AGE Caregiver Josh Burkey and teacher Jeanna Tipton with twenty school aged children ages 5-6 years old.
2 21 SCHOOL AGE Caregiver Cami Dabbs and teacher Rebecca Hager with twenty one school aged children aged 5-6 years old.

 
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
A school-age health report form(s) used was not supplied by the department or did not contain all the required information as evidenced by one child did not have a completed "parent's health statement for school age child".
Licensing Rule Reference
19 CSR 30-62.122 Medical Examination Reports (2) (E) states: The medical examination report form and the health history report for school-age children 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
Child medical requirements shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
Medical examination report was not on file for Cami Dabbs 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

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
Violation
 Provider Comments
Violation
Requirements for immunization reports on file were not met as evidenced by for two children immunization record(s) was/were not on file .
Licensing Rule Reference
19 CSR 30-62.192 Health Care (4) (A) states: No child shall be permitted to enroll in or attend any day care facility caring for ten (10) or more children unless the child has been immunized adequately against vaccine preventable childhood illnesses specified by the department in accordance with recommendations of the Immunization Practices Advisory Committee (ACIP). The parent or guardian of the child shall provide satisfactory evidence of the required immunizations. Satisfactory evidence means a statement, certificate or record from a physician or other recognized health facility or personnel, stating that the required immunizations have been given to the child and verifying the type of vaccine and the month, day and year of administration.
Correction Required
Child immunization requirements shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

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