DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

NORTHSIDE YOUTH AND SENIOR SERVICE CENTER, INC.

000335720

(314) 723-3069

1224 S 14TH ST
ST LOUIS
MO  63104

NORTHSIDE YOUTH AND SENIOR SERVICE CENTER, INC.

4120 MAFFITT AVE
ST LOUIS
MO  63113

AVANT, DOMINIQUE ALVIN

davant@nsyssc.com

Incorporated

JOYCE E GREEN

5 YEARS - 12 YEARS

50

SCHOOL AGE

AFTER SCHOOL CARE ONLY
 
Inspection Information

02/24/2022

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2418608573


DocumentDocument-Date
DIRECTOR'S JOB RESPONSIBILITIES 04/10/2007
DAILY SCHEDULE 04/10/2007
SAMPLE WEEKLY MENU 04/10/2007
SAMPLE FORMS 04/10/2007
POLICIES 04/10/2007
DISCIPLINE POLICIES 04/10/2007
LINES OF ADMINISTRATIVE AUTHORITY 04/10/2007
JOB RESPONSIBILITIES 04/10/2007
DIRECTOR'S QUALIFICATIONS 03/31/2015
ARTICLES OF INCORPORATION 03/16/2007
CHILD CARE PRACTICES 04/02/2007
STAFF SHEET 01/30/2017
APPLICATION 02/11/2019
ANNUAL DECLARATION 03/09/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 03/09/2021
EQUIPMENT LIST 03/09/2021




Inspection determined facility to be in compliance with licensing rules.
Compliance 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.

Compliance List
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 requirements for obtaining 12 clock hours each calendar year were not met. For the calendar year of 2020, the staff listed need the following information: Dominique Avant needs 3hrs and James Griggs needs 6hrs.
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
2/24/2022
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 Dominique Avant and James Griggs .
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
10/13/2021
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
Violation
 Provider Comments
Violation
One 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
Three child(ren) records did not include full name, home address, employers name and address, work schedule and home and work telephone numbers of the 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
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