DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

YMCA-O'FALLON BRANCH-DARDENNE ELEMENTARY

000271978

(636) 293-6484

2621 HIGHWAY K
O FALLON
MO  63366

GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

3451 PHEASANT MEADOW DR
O FALLON
MO  63368-7324

MILLER, CHRISTINA

Laurie.mctearnen@gwrymca.org

Incorporated

CHARMEL WILLIAMS

5 YEARS - 12 YEARS

32

SCHOOL AGE

BEFORE AND AFTER SCHOOL CARE ONLY
 
Inspection Information

11/10/2021

7:45 AM

8:22 AM

UNANNOUNCED

COMPLIANCE MONITORING

2412392147


DocumentDocument-Date
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 11/02/2021
DISASTER AND EMERGENCY PREPAREDNESS PLAN 11/02/2021
ANNUAL DECLARATION 09/20/2021
SAMPLE WEEKLY MENU 05/15/1992
SAMPLE FORMS 05/15/1992
REGISTERING FICTITIOUS NAMES 05/15/1992
POLICIES 05/15/1992
LOCAL FIRE DEPARTMENT NOTIFICATION 05/15/1992
LINES OF ADMINISTRATIVE AUTHORITY 05/15/1992
JOB RESPONSIBILITIES 05/15/1992
DISCIPLINE POLICIES 05/15/1992
DIRECTOR'S JOB RESPONSIBILITIES 05/08/1992
DAILY SCHEDULE 05/15/1992
CHILD CARE PRACTICES 05/15/1992
DIRECTOR'S QUALIFICATIONS 10/26/2010
CERTIFICATE OF INCORPORATION 02/25/1898
ARTICLES OF INCORPORATION 05/15/1992
CERTIFICATE OF GOOD STANDING 10/16/2018
APPLICATION 09/27/2018
EQUIPMENT LIST 08/23/2021
STAFF SHEET 10/04/2018




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 2
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 2
Total Children 14
StaffChildClass AgeNote
2 14 SCHOOL AGE Jason Manes Site Director and Debbie Layne Group Leader were present with fourteen children ages five to twelve years old

 
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
Violation
 Provider Comments
Violation
Medical examination report did not include a completed Risk Assessment for Tuberculosis form for Brooklyn Gorman.
Licensing Rule Reference
5 CSR 25-500.122 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

Violation
Medical examination report was not on file for Brooklyn Gorman as evidenced by a medical examination was not on file at the facility at the time of initial licensure.
Licensing Rule Reference
5 CSR 25-500.122 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

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