DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

YMCA-KIRKWOOD BRANCH-OUR LADY OF LOURDES

000304763

(314) 965-9622

7157 NORTHMOOR DR
UNIVERSITY CITY
MO  63105

GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

325 N TAYLOR AVE
KIRKWOOD
MO  63122-4411

BERGMAN, JENNIFER LEANN

jennifer.bergman@gwrymca.org

Incorporated

JOYCE E GREEN

5 YEARS - 13 YEARS

48

SCHOOL AGE

AFTER SCHOOL CARE ONLY
 
Inspection Information

11/10/2021

2:30 PM

3:51 PM

UNANNOUNCED

COMPLIANCE MONITORING

2412830520


DocumentDocument-Date
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 10/29/2021
SAMPLE WEEKLY MENU 09/07/1988
SAMPLE FORMS 09/07/1988
POLICIES 09/07/1988
LINES OF ADMINISTRATIVE AUTHORITY 09/07/1988
JOB RESPONSIBILITIES 09/07/1988
DISCIPLINE POLICIES 09/07/1988
DIRECTOR'S JOB RESPONSIBILITIES 09/07/1988
DAILY SCHEDULE 09/07/1988
CHILD CARE PRACTICES 09/07/1988
CERTIFICATE OF INCORPORATION 09/07/1988
ARTICLES OF INCORPORATION 10/04/2016
CERTIFICATE OF GOOD STANDING 12/20/2016
REGISTERING FICTITIOUS NAMES 01/18/2016
DIRECTOR'S QUALIFICATIONS 10/24/2017
APPLICATION 10/22/2018
DISASTER AND EMERGENCY PREPAREDNESS PLAN 10/23/2018
STAFF SHEET 10/23/2020
EQUIPMENT LIST 10/29/2021
ANNUAL DECLARATION 10/29/2021




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 3
Total Children 24
StaffChildClass AgeNote
3 24 SCHOOL AGE Kelly Holts, Site Director, Helen Radford, teacher, and John Hoffman, teacher, were present with twenty-four children, ages 5 to 12 years.

 
5 CSR 25-500.032 Organization and Administration
Compliance
5 CSR 25-500.042 Licensing Process
Violation
 Provider Comments
Violation
The name, address and telephone number of the board chairperson was not prominently posted near the license.
Licensing Rule Reference
5 CSR 25-500.042 Licensing Process (13) (C) states: Board president or chairperson;
Correction Required
The name, address, and board president or chairperson shall be posted near the license.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-500.052 Annual Requirements
Violation
 Provider Comments
Violation
The Family Care Safety Registry check was not conducted for Kelly Holts, Helen Radford, Gabby Gravelle, John Hoffman and Jennifer Bergman within thirty (30) days prior to the anniversary date.
Licensing Rule Reference
5 CSR 25-500.052 Annual Requirements (2) (C) states: The child care provider shall conduct a Family Care Safety Registry check for all child care staff members within thirty (30) days prior to the anniversary date as printed on the license.
Correction Required
Required Family Care Safety Registry checks shall be conducted for all child care staff member(s) within thirty (30) days prior to the anniversary date.

Correction Verification
Submit Documentation

Compliance Date

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
Violation
 Provider Comments
Violation
Requirements for immunization reports on file were not met as evidenced by 2 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
10/13/2021
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
Violation
 Provider Comments
Violation
1 child(ren) records did not include child's address.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (A) states: The child's full name, address, birth-date and the date care begins and ends;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
10/13/2021
Violation
1 child(ren) records did not include date care begins and ends.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (A) states: The child's full name, address, birth-date and the date care begins and ends;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
10/13/2021
Violation
1 child(ren) records did not include employers' address of parent(s), guardian or legal custodian.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
10/13/2021
Violation
1 child(ren) records did not include field trip and transportation authorization.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (F) states: Field trip and transportation authorization.
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
10/13/2021
Violation
Four child(ren) records did not include date care begins and ends.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (A) states: The child's full name, address, birth-date and the date care begins and ends;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
11/10/2021
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