MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
JEFFERSON CITY AREA YOUNG MEN'S CHRISTIAN ASSOCIATION

Facility DVN
000189335

Phone
(573) 761-3196

Physical Address
285 S SUMMIT DR
HOLTS SUMMIT
MO 65043-1445

Owner
JEFFERSON CITY AREA YOUNG MEN'S CHRISTIAN ASSOCIATION

Mailing Address
PO BOX 104176
JEFFERSON CITY
MO 65110-4176

Provider/Director
WALKER, ADRIANNA ROSE

E-mail Address
JKEVER@JCYMCA.ORG

Incorporated
Incorporated

Child Care Specialist
JOY LYNN NICHOLS

Age Range
5 YEARS - 12 YEARS

Capacity
99

Facility Type
SCHOOL AGE

Limitations

Inspection Information

Date
04/26/2022

Arrival Time
3:25 PM

Departure Time
4:10 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2422546064

Document	Document-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
DISASTER AND EMERGENCY PREPAREDNESS PLAN	12/03/2013
LICENSING ORIENTATION	08/05/1985
ARTICLES OF INCORPORATION	08/05/1985
LOCAL FIRE DEPARTMENT NOTIFICATION	08/05/1985
OWNER/PROVIDER REFERENCES	04/12/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	03/17/2022
EQUIPMENT LIST	03/17/2022
ANNUAL DECLARATION	03/17/2022

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 4

Total Children 43

Staff	Child	Class Age	Note
4	43	SCHOOL AGE	children ages 5-11; Adrianna Walker, Sydney Crockett, Lanie Lowry, and Emily Scrivner


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