DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

TRI-STATE FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION

002083687

(417) 455-9999

12350 NORWAY RD
NEOSHO
MO  64850-6632

TRI-STATE FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION

4701 CHOUTEAU DR
NEOSHO
MO  64850-9123

KEPLAR, CLARA ALICE

tina@tristatefamilyymca.org

Incorporated

ANGEL DONSON

5 YEARS - 12 YEARS

60

SCHOOL AGE

AFTER SCHOOL CARE ONLY
 
Inspection Information

09/15/2022

4:44 PM

5:20 PM

UNANNOUNCED

COMPLIANCE MONITORING

2430996801


DocumentDocument-Date
POLICIES 08/08/2007
JOB RESPONSIBILITIES 08/08/2007
DAILY SCHEDULE 08/08/2007
ARTICLES OF INCORPORATION 08/08/2007
LINES OF ADMINISTRATIVE AUTHORITY 01/03/2008
CHILD CARE PRACTICES 08/08/2007
DISCIPLINE POLICIES 08/08/2007
CERTIFICATE OF GOOD STANDING 10/09/2015
STAFF SHEET 11/13/2019
APPLICATION 11/13/2019
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 03/24/2022
EQUIPMENT LIST 03/24/2022
ANNUAL DECLARATION 01/27/2022




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 2
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 16
StaffChildClass AgeNote
3 16 SCHOOL AGE Caregivers Katelyn Lett, Emma Scroggins and Clara Keplar with 16 children ages 5-11 years old.

 
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 manager(s) was not prominently posted near the license.
Licensing Rule Reference
5 CSR 25-500.042 Licensing Process (13) (D) states: All manager(s) and/or member(s).
Correction Required
The name, address, and phone number of the LLC member(s) or LLC manager(s) shall be posted near the license.

Correction Verification
Submit Documentation

Compliance Date

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
Violation
 Provider Comments
Violation
A medical examination report did not include either a completed Risk Assessment for Tuberculosis form or a negative tuberculin skin test (TST) within 12 months of the individual's begin date at the facility for the following staff: Emma Scroggins and Michelle Bowling.
Licensing Rule Reference
5 CSR 25-500.122 Medical Examination Reports (1) (B) . states: Medical examination reports shall include either a Tuberculosis (TB) Risk Assessment form, completed and signed by a health care professional, or a negative tuberculin skin test (TST) completed not more than twelve (12) months before beginning work in the facility. The Tuberculosis (TB) Risk Assessment form, revised March 2014, is incorporated by reference in this rule, as published by the Missouri Department of Health and Senior Services, PO Box 570, Jefferson City, MO 65102 and available by the Missouri Department of Health and Senior Services at https://health.mo.gov/living/healthcondiseases/communicable/tuberculosis/tbmanual/pdf/RiskAssessmentform.pdf. If the person has signs or symptoms of tuberculosis, or risk factors for tuberculosis, then testing for tuberculosis shall occur.
Correction Required
Medical examination reports shall include Risk Assessment for Tuberculosis forms or negative tuberulin skin test (TST) as required.

Correction Verification
Submit Documentation

Compliance Date

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