MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
YMCA-FOUR RIVERS BRANCH-NEW HAVEN ELEMENTARY

Facility DVN
002767439

Phone
(636) 239-5704

Physical Address
201 ELTON AVE
NEW HAVEN
MO 63068-1194

Owner
GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

Mailing Address
400 GRAND AVE
WASHINGTON
MO 63090-1204

Provider/Director
JUST, KRISTY MARIE

E-mail Address
melissa.mueller@gwrymca.org

Incorporated
Incorporated

Child Care Specialist
CYNTHIA D MADDOX

Age Range
5 YEARS - 12 YEARS

Capacity
20

Facility Type
SCHOOL AGE

Limitations

Inspection Information

Date
04/11/2022

Arrival Time
9:25 AM

Departure Time
9:50 AM

Notice
ANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2421773024

Document	Document-Date
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	04/08/2022
EQUIPMENT LIST	04/08/2022
ANNUAL DECLARATION	04/08/2022

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.

Attendance at Time of Inspection

Total Staff 1

Staff	Child	Class Age	Note
1	0	NO CHILDREN IN ATTENDANCE	Melissa Mueller was present for the inspection. There are no children enrolled due to inactive status.

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 Compliance
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 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