MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

Back

Facility Information

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

Facility DVN
001779428

Phone
(573) 754-6904

Physical Address
500 HALEY AVE
LOUISIANA
MO 63353-2417

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

Mailing Address
614 KELLY LN
LOUISIANA
MO 63353-2409

Provider/Director
PEDERSEN, TERESA LEE

E-mail Address
Noveta.Shepherd@twinpikefamilyymca.org

Incorporated
Incorporated

Child Care Specialist
JOY LYNN NICHOLS

Age Range
5 YEARS - 13 YEARS

Capacity
96

Facility Type
SCHOOL AGE

Limitations

Inspection Information

Date
12/10/2021

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2414084489

Document	Document-Date
SAMPLE FORMS	09/05/2003
LINES OF ADMINISTRATIVE AUTHORITY	08/27/2007
POLICIES	09/05/2003
SAMPLE WEEKLY MENU	09/05/2003
DAILY SCHEDULE	06/01/2004
CERTIFICATE OF GOOD STANDING	09/24/2013
DIRECTOR'S QUALIFICATIONS	09/24/2013
APPLICATION	08/22/2019
STAFF SHEET	09/19/2019
CHILD CARE PRACTICES	07/10/2003
DISCIPLINE POLICIES	09/05/2003
DIRECTOR'S JOB RESPONSIBILITIES	09/20/2005
ARTICLES OF INCORPORATION	10/29/2002
LOCAL FIRE DEPARTMENT NOTIFICATION	10/29/2003
JOB RESPONSIBILITIES	07/10/2003
CERTIFICATE OF INCORPORATION	10/29/2003
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	09/27/2021
EQUIPMENT LIST	09/27/2021
ANNUAL DECLARATION	09/27/2021

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.