MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT

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Facility Information

Facility Name
MEXICO AREA FAMILY YMCA INC.

Facility DVN
001379995

Phone
(573) 581-1540

Physical Address
1127 ADAMS ST
MEXICO
MO 65265-2288

Owner
MEXICO AREA FAMILY YMCA INC.

Mailing Address

Provider/Director
JORGENSEN, JUSTINE

E-mail Address
samantha.wilson@mexicoymca.org

Incorporated
Incorporated

Child Care Specialist
SUSAN MARIE DOUGLAS

Age Range
5 YEARS - 12 YEARS

Capacity
45

Facility Type
GROUP HOME AND CENTER

Limitations

Inspection Information

Date
09/01/2022

Arrival Time
2:30 PM

Departure Time
3:32 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2430270846

Document	Document-Date
POLICIES	08/07/2017
CHILD CARE PRACTICES	08/07/2017
DIAGRAM/INDOOR	07/25/2017
DIAGRAM/OUTDOOR	08/07/2017
DISCIPLINE POLICIES	08/07/2017
ARTICLES OF INCORPORATION	07/25/2017
SAMPLE FORMS	08/07/2017
APPLICATION	03/11/2019
STAFF SHEET	05/07/2019
DIRECTOR'S QUALIFICATIONS	10/15/2018
DISASTER AND EMERGENCY PREPAREDNESS PLAN	07/25/2017
ANNUAL DECLARATION	02/10/2021
SANITATION INSPECTION	12/07/2021
CERTIFICATE OF GOOD STANDING	02/03/2022
FIRE/SAFETY INSPECTION	12/06/2021
EQUIPMENT LIST	03/07/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	03/07/2022
SAMPLE WEEKLY MENU	07/27/1999
LOCAL ZONING APPROVAL	03/18/2022
LINES OF ADMINISTRATIVE AUTHORITY	03/11/2022
JOB RESPONSIBILITIES	03/11/2022
DAILY SCHEDULE	03/11/2022

Inspection determined facility to be in compliance with licensing rules.

Open Violations: 3

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 3

Total Children 21

Staff	Child	Class Age	Note
3	21	SCHOOL AGE	Samantha Wilson, , director of child care programs, Justine Jorgensen, director, Jordain Barnett, staff were present with 21 children ages 5 to 10