DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

JEFFERSON CITY AREA YOUNG MEN'S CHRISTIAN ASSOCIATION

000189335

(573) 761-3196

285 S SUMMIT DR
HOLTS SUMMIT
MO  65043-1445

JEFFERSON CITY AREA YOUNG MEN'S CHRISTIAN ASSOCIATION

PO BOX 104176
JEFFERSON CITY
MO  65110-4176

GREEN, JORDAN ROBERT

JKEVER@JCYMCA.ORG

Incorporated

CHRISTINA BRUCE

5 YEARS - 12 YEARS

99

SCHOOL AGE

 
Inspection Information

01/28/2022

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2416978698


DocumentDocument-Date
DIRECTOR'S QUALIFICATIONS 12/13/2012
DISCIPLINE POLICIES 08/05/1985
DIRECTOR'S JOB RESPONSIBILITIES 08/26/1993
JOB RESPONSIBILITIES 08/05/1985
LINES OF ADMINISTRATIVE AUTHORITY 08/05/1985
CHILD CARE PRACTICES 08/05/1985
DAILY SCHEDULE 08/05/1985
POLICIES 08/05/1985
SAMPLE FORMS 08/10/1984
SAMPLE WEEKLY MENU 08/05/1985
CERTIFICATE OF INCORPORATION 07/19/1984
APPLICATION 04/03/2019
CERTIFICATE OF GOOD STANDING 04/12/2021
STAFF SHEET 04/12/2021
EQUIPMENT LIST 04/12/2021
ANNUAL DECLARATION 04/12/2021
DISASTER AND EMERGENCY PREPAREDNESS PLAN 12/03/2013
LICENSING ORIENTATION 08/05/1985
ARTICLES OF INCORPORATION 08/05/1985
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 04/12/2021
LOCAL FIRE DEPARTMENT NOTIFICATION 08/05/1985
OWNER/PROVIDER REFERENCES 04/12/2021




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 director was not responsible for the daily planning, monitoring and managing of the facilities program as evidence by the previous director left and a new director had not yet been approved.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (2) (A) 1. . states: An approved certificated group child care home provider or center director shall be responsible for planning, monitoring, and managing the facility’s daily program.
Correction Required
The director or group home provider shall be responsible for the daily program.

Correction Verification
Submit Documentation

Compliance Date
1/27/2022
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 Sydney Crockett and Iris Desha.
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
1/24/2022
Violation
Medical examination report was not on file for Sydney Crockett and Iris DeSha as evidenced by a medical examination was not on file within 30 days of an individual beginning to work with children.
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
1/24/2022
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
Violation
 Provider Comments
Violation
Criminal background check results were not on file for Brittany Watkins, Sydney Crockett, Amajes Boyd, Iris Desha.
Licensing Rule Reference
5 CSR 25-600.020 General Requirements (1) states: Prior to the employment or presence of a child care staff member in a family child care home, group child care home, child care center, or license-exempt facility not exempted by section 210.1080.13, RSMo, the child care provider shall request the results of a criminal background check for such child care staff member from the department.
Correction Required
Required results of criminal background checks shall be on file.

Correction Verification
Submit Documentation

Compliance Date
1/27/2022
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