MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
TWIN PIKE FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.

Facility DVN
001779419

Phone
(573) 754-5412

Physical Address
23526 PIKE 9247
LOUISIANA
MO 63353-4103

Owner
TWIN PIKE FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.

Mailing Address
614 KELLY LN
LOUISIANA
MO 63353-2409

Provider/Director
LOVELL, LESLIE ALANE

E-mail Address
cassie.spangler@twinpikefamilyymca.org

Incorporated
Incorporated

Child Care Specialist
JOY LYNN NICHOLS

Age Range
5 YEARS - 15 YEARS

Capacity
32

Facility Type
SCHOOL AGE

Limitations

Inspection Information

Date
11/09/2021

Arrival Time
3:30 PM

Departure Time
4:03 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2412242004

Document	Document-Date
SAMPLE FORMS	09/02/2003
DISCIPLINE POLICIES	09/02/2003
LINES OF ADMINISTRATIVE AUTHORITY	09/02/2003
DIRECTOR'S QUALIFICATIONS	08/02/2008
STAFF SHEET	09/16/2019
APPLICATION	08/21/2019
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	10/18/2021
EQUIPMENT LIST	10/18/2021
ANNUAL DECLARATION	10/18/2021

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 4

Total Children 20

Staff	Child	Class Age	Note
2	14	SCHOOL AGE	children ages five to nine; Leslie Lovell and John Fulton
2	6	SCHOOL AGE	children ages nine to thirteen; Marla Ries and Scott Smith


5 CSR 25-500.032 Organization and Administration Compliance
5 CSR 25-500.042 Licensing Process Compliance
5 CSR 25-500.052 Annual Requirements Compliance
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers Compliance
5 CSR 25-500.090 Disaster and Emergency Preparedness Compliance
5 CSR 25-500.092 Furniture, Equipment and Materials Compliance
5 CSR 25-500.102 Personnel Compliance
5 CSR 25-500.112 Staff/Child Ratios Compliance
5 CSR 25-500.122 Medical Examination Reports Compliance
5 CSR 25-500.132 Admission Policies and Procedures Compliance
5 CSR 25-500.172 Emergency School Closings Compliance
5 CSR 25-500.182 Child Care Program Compliance
5 CSR 25-500.192 Health Care Compliance
5 CSR 25-500.202 Nutrition and Food Service Compliance
5 CSR 25-500.212 Transportation and Field Trips Compliance
5 CSR 25-500.222 Records and Reports Compliance
5 CSR 25-600.020 General Requirements Compliance
5 CSR 25-600.040 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