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

05/03/2022

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2423040545


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 03/25/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 03/25/2022
EQUIPMENT LIST 03/25/2022




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
Violation
 Provider Comments
Violation
The name, address and telephone number of the board chairperson was not prominently posted near the license.
Licensing Rule Reference
5 CSR 25-500.042 Licensing Process (13) (C) states: Board president or chairperson;
Correction Required
The name, address, and board president or chairperson shall be posted near the license.

Correction Verification
Submit Documentation

Compliance Date
5/2/2022
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
Violation
 Provider Comments
Violation
Requirements for immunization reports on file were not met as evidenced by one 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
5/3/2022
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