MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
Y-CLUB @ LEWIS & CLARK MIDDLE SCHOOL

Facility DVN
002855567

Phone
(573) 659-3000

Physical Address
325 LEWIS AND CLARK DR
JEFFERSON CITY
MO 65101-5586

Owner
JEFFERSON CITY AREA YOUNG MEN'S CHRISTIAN ASSOCIATION

Mailing Address
PO BOX 104176
JEFFERSON CITY
MO 65110-4176

Provider/Director
KINGSOLVER, LINDSEY

E-mail Address
jkever@jcymca.org

Incorporated
Incorporated

Child Care Specialist
LAUREN R RAYWARNKE

Age Range
11 YEARS - 14 YEARS

Capacity
60

Facility Type
SCHOOL AGE

Limitations
BEFORE SCHOOL CARE ONLY

Inspection Information

Date
11/19/2021

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2412781735

Document	Document-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 25-500.112 Staff/Child Ratios Compliance
5 CSR 25-500.172 Emergency School Closings Compliance