DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

THE ADAIR COUNTY FAMILY YMCA, INC.

002892777

(660) 665-1922

2010 E NORMAL AVE
KIRKSVILLE
MO  63501-3321

THE ADAIR COUNTY FAMILY YMCA, INC.

1708 S JAMISON ST
KIRKSVILLE
MO  63501

MEEHAN, DIANE MARQUERITE

krouner@adairymca.org

Incorporated

BETHANY C DUCKWORTH

8 YEARS - 12 YEARS

100

SCHOOL AGE

 
Inspection Information

03/29/2022

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2420490481


DocumentDocument-Date
SAMPLE WEEKLY MENU 07/26/2021
POLICIES 07/26/2021
EQUIPMENT LIST 07/26/2021
DISCIPLINE POLICIES 07/26/2021
DISASTER AND EMERGENCY PREPAREDNESS PLAN 07/26/2021
DIRECTOR'S QUALIFICATIONS 05/21/2021
DAILY SCHEDULE 07/26/2021
CHILD CARE PRACTICES 07/26/2021
CERTIFICATE OF INCORPORATION 07/26/2021
CERTIFICATE OF GOOD STANDING 07/26/2021
ARTICLES OF INCORPORATION 12/15/2017
APPLICATION 05/20/2021
SAMPLE FORMS 07/26/2021
JOB RESPONSIBILITIES 07/21/2021
LINES OF ADMINISTRATIVE AUTHORITY 07/27/2021
LICENSING ORIENTATION 07/26/2021
DIRECTOR'S JOB RESPONSIBILITIES 07/27/2021




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.

 
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
Compliance
5 CSR 25-500.112 Staff/Child Ratios
Compliance
5 CSR 25-500.122 Medical Examination Reports
Violation
 Provider Comments
Violation
A school-age health report form(s) used was not supplied by the department or did not contain all the required information as evidenced by two school age health reports were not signed by the parents/guardians.
Licensing Rule Reference
5 CSR 25-500.122 Medical Examination Reports (2) (E) states: The medical examination report form and the health history report for school-age children shall be supplied by the department or the facility may use its own form if it contains all the information on the department's form.
Correction Required
Child medical requirements shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date
3/29/2022
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
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