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


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 25-500.087 Fire Safety 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 25-500.142 Nighttime Care Compliance
5 CSR 25-500.162 Overlap Care of Children 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
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 Violation
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