MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

Back

Facility Information

Facility Name
Y-CLUB @ THOMAS JEFFERSON MIDDLE SCHOOL

Facility DVN
002782878

Phone
(573) 659-3250

Physical Address
1201 FAIRGROUNDS RD
JEFFERSON CITY
MO 65109-5445

Owner
JEFFERSON CITY AREA YOUNG MEN'S CHRISTIAN ASSOCIATION

Mailing Address
PO BOX 104176
JEFFERSON CITY
MO 65110-4176

Provider/Director
HOOD III, WALTER LEE

E-mail Address
jkever@jcymca.org

Incorporated
Incorporated

Child Care Specialist
LAUREN R RAYWARNKE

Age Range
11 YEARS - 14 YEARS

Capacity
60

Facility Type
SCHOOL AGE

Limitations
BEFORE SCHOOL CARE ONLY

Inspection Information

Date
07/20/2022

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2427435530

Document	Document-Date
APPLICATION	07/30/2019
ARTICLES OF INCORPORATION	07/15/2019
REGISTERING FICTITIOUS NAMES	07/25/2019
CERTIFICATE OF GOOD STANDING	07/25/2019
DISCIPLINE POLICIES	07/25/2019
DISASTER AND EMERGENCY PREPAREDNESS PLAN	07/25/2019
DAILY SCHEDULE	07/25/2019
LINES OF ADMINISTRATIVE AUTHORITY	07/25/2019
SAMPLE FORMS	07/25/2019
POLICIES	07/25/2019
STAFF SHEET	08/13/2019
LOCAL FIRE DEPARTMENT NOTIFICATION	08/13/2019
JOB RESPONSIBILITIES	08/13/2019
CHILD CARE PRACTICES	08/13/2019
DIRECTOR'S JOB RESPONSIBILITIES	08/13/2019
CERTIFICATE OF INCORPORATION	07/25/2019
DIRECTOR'S QUALIFICATIONS	08/26/2019
EQUIPMENT LIST	03/18/2022
ANNUAL DECLARATION	03/18/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	03/18/2022

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.

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 Violation
5 CSR 25-500.092 Furniture, Equipment and Materials Compliance
5 CSR 25-500.102 Personnel Violation
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