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

02/09/2022

6:30 AM

7:46 AM

UNANNOUNCED

COMPLIANCE MONITORING

2417584179


DocumentDocument-Date
SAMPLE FORMS 12/21/2020
EQUIPMENT LIST 02/07/2022
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
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 02/07/2022
ANNUAL DECLARATION 02/07/2022




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 4
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 3
StaffChildClass AgeNote
3 3 SCHOOL AGE Lindsey Kingsolver, Destiny Williams and Christina Ward with three children age 12.

 
5 CSR 25-500.032 Organization and Administration
Compliance
5 CSR 25-500.042 Licensing Process
Violation
 Provider Comments
Violation
Posting requirements were not met as evidenced by the posted license was outdated.
Licensing Rule Reference
5 CSR 25-500.042 Licensing Process (12) states: Once granted, the license shall be posted near the entrance of the facility where it may be seen easily by parents or others who visit.
Correction Required
The official license shall be posted.

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 Destiny Williams 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
Violation
 Provider Comments
Violation
The requirements for obtaining 12 clock hours each calendar year were not met. For the calendar year of 2021, the staff listed need the following information: Christina Ward needs 4 hours of training for 2021 and Destiny Williams needs 3.50 hours of training for 2021.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (3) (A) states: The center director, group child care home provider, all other caregivers, and those volunteers who are counted in staff/child ratios shall obtain at least twelve (12) clock hours of child-care related training during each calendar year. Clock hour training shall be approved by the department.
Correction Required
Required training hours shall be documented for each caregiver.

Correction Verification
Submit Documentation

Compliance Date

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 1 child'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

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