DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

Y-CLUB @ LEWIS & CLARK MIDDLE SCHOOL

002855567

(573) 659-3000

325 LEWIS AND CLARK DR
JEFFERSON CITY
MO  65101-5586

JEFFERSON CITY AREA YOUNG MEN'S CHRISTIAN ASSOCIATION

PO BOX 104176
JEFFERSON CITY
MO  65110-4176

KINGSOLVER, LINDSEY

jkever@jcymca.org

Incorporated

LAUREN R RAYWARNKE

11 YEARS - 14 YEARS

60

SCHOOL AGE

BEFORE SCHOOL CARE ONLY
 
Inspection Information

11/19/2021

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2412781735


DocumentDocument-Date
SAMPLE FORMS 12/21/2020
EQUIPMENT LIST 12/21/2020
REGISTERING FICTITIOUS NAMES 10/08/2020
APPLICATION 09/22/2020
JOB RESPONSIBILITIES 01/06/2021
DIRECTOR'S JOB RESPONSIBILITIES 01/06/2021
LINES OF ADMINISTRATIVE AUTHORITY 01/06/2021
DAILY SCHEDULE 01/06/2021
DISASTER AND EMERGENCY PREPAREDNESS PLAN 01/06/2021
DIRECTOR'S QUALIFICATIONS 09/23/2020
POLICIES 12/21/2020
CHILD CARE PRACTICES 12/21/2020
DISCIPLINE POLICIES 12/21/2020
CERTIFICATE OF INCORPORATION 12/21/2020
CERTIFICATE OF GOOD STANDING 12/21/2020
ARTICLES OF INCORPORATION 12/21/2020
LOCAL FIRE DEPARTMENT NOTIFICATION 02/04/2021
LICENSING ORIENTATION 10/05/2020
STAFF SHEET 03/03/2021




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.

 
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
Violation
 Provider Comments
Violation
The requirements for first aid/CPR were not met as evidenced by there was no documentation on file showing completion of age-appropriate CPR certification for the requested/licensed capacity.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (1) (T) states: The licensee shall have documentation on file at the facility of current certification in age-appropriate first aid and cardiopulmonary resuscitation (CPR) training for a sufficient number of child care staff to ensure that there is one (1) caregiver at the facility for every twenty (20) children in the licensed capacity. At least one (1) caregiver with current certification in age appropriate first aid and CPR must be on site at all times when children are present. The training shall be certified by a nationally-recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification, include an in-person skills assessment, and be [and] approved by the department.
Correction Required
Required age-appropriate certification in first aid/CPR shall be on file, with at least one caregiver with certification on site.

Correction Verification
Submit Documentation

Compliance Date
11/16/2021
Violation
The requirements for first aid/CPR were not met as evidenced by there was no documentation on file showing completion of age-appropriate first aid certification for the requested/licensed capacity.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (1) (T) states: The licensee shall have documentation on file at the facility of current certification in age-appropriate first aid and cardiopulmonary resuscitation (CPR) training for a sufficient number of child care staff to ensure that there is one (1) caregiver at the facility for every twenty (20) children in the licensed capacity. At least one (1) caregiver with current certification in age appropriate first aid and CPR must be on site at all times when children are present. The training shall be certified by a nationally-recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification, include an in-person skills assessment, and be [and] approved by the department.
Correction Required
Required age-appropriate certification in first aid/CPR shall be on file, with at least one caregiver with certification on site.

Correction Verification
Submit Documentation

Compliance Date
11/16/2021
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
Violation
 Provider Comments
Violation
Requirements for immunization reports on file were not met as evidenced by 2 children's immunization record(s) was/were not on file .
Licensing Rule Reference
5 CSR 25-500.192 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
11/18/2021
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