MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
TWIN PIKE FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.

Facility DVN
002064402

Phone
(573) 324-8461

Physical Address
700 W ADAMS ST
BOWLING GREEN
MO 63334-2046

Owner
TWIN PIKE FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.

Mailing Address
614 KELLY LN
LOUISIANA
MO 63353-2409

Provider/Director
SNELL, DEBRA JUNE

E-mail Address
cassie.spangler@twinpikefamilyymca.org

Incorporated
Incorporated

Child Care Specialist
CHRISTINA BRUCE

Age Range
5 YEARS - 13 YEARS

Capacity
120

Facility Type
SCHOOL AGE

Limitations

Inspection Information

Date
05/17/2022

Arrival Time
2:45 PM

Departure Time
4:31 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2425031336

Document	Document-Date
SAMPLE FORMS	09/04/2007
LINES OF ADMINISTRATIVE AUTHORITY	08/27/2007
LOCAL FIRE DEPARTMENT NOTIFICATION	09/04/2007
DIRECTOR'S JOB RESPONSIBILITIES	09/04/2007
DIRECTOR'S QUALIFICATIONS	04/09/2009
DAILY SCHEDULE	09/04/2007
CHILD CARE PRACTICES	10/02/2007
CERTIFICATE OF INCORPORATION	09/04/2007
CERTIFICATE OF GOOD STANDING	03/07/2012
ARTICLES OF INCORPORATION	09/04/2007
APPLICATION	02/14/2019
STAFF SHEET	04/08/2019
ANNUAL DECLARATION	05/14/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	05/14/2021
EQUIPMENT LIST	05/17/2022

Inspection determined facility to be in compliance with licensing rules.

Open Violations: 5

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 7

Total Children 64

Staff	Child	Class Age	Note
2	0	NO CHILDREN IN ATTENDANCE	Debra Snell, director and Frank Becher, staff were present at inspection
1	16	SCHOOL AGE	Pam Watts , staff was present with 16 school age children ages 7 to 8
1	14	SCHOOL AGE	Karen Shinn , staff was present with 14 school age children ages 7 to 9
1	11	SCHOOL AGE	Sidney Smith staff was present at the inspection with 11 school age children ages 9- 12
2	23	SCHOOL AGE	Linda Arnold , staff and Andrea Ankrom staff were present with 23 school age children age 5 to 7


5 CSR 25-500.032 Organization and Administration Compliance
5 CSR 25-500.042 Licensing Process Compliance
5 CSR 25-500.052 Annual Requirements Violation
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 Violation
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