MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
THE ADAIR COUNTY FAMILY YMCA, INC.

Facility DVN
002892777

Phone
(660) 665-1922

Physical Address
2010 E NORMAL AVE
KIRKSVILLE
MO 63501-3321

Owner
THE ADAIR COUNTY FAMILY YMCA, INC.

Mailing Address
1708 S JAMISON ST
KIRKSVILLE
MO 63501

Provider/Director
MEEHAN, DIANE MARQUERITE

E-mail Address
krouner@adairymca.org

Incorporated
Incorporated

Child Care Specialist
BETHANY C DUCKWORTH

Age Range
8 YEARS - 12 YEARS

Capacity
100

Facility Type
SCHOOL AGE

Limitations

Inspection Information

Date
09/28/2022

Arrival Time
2:35 PM

Departure Time
3:48 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2431896234

Document	Document-Date
APPLICATION	05/20/2021
CERTIFICATE OF GOOD STANDING	07/26/2021
CERTIFICATE OF INCORPORATION	07/26/2021
CHILD CARE PRACTICES	07/26/2021
DAILY SCHEDULE	07/26/2021
DIRECTOR'S QUALIFICATIONS	05/21/2021
DISASTER AND EMERGENCY PREPAREDNESS PLAN	07/26/2021
DISCIPLINE POLICIES	07/26/2021
EQUIPMENT LIST	08/31/2022
POLICIES	07/26/2021
SAMPLE WEEKLY MENU	07/26/2021
ARTICLES OF INCORPORATION	12/15/2017
SAMPLE FORMS	07/26/2021
LINES OF ADMINISTRATIVE AUTHORITY	07/27/2021
JOB RESPONSIBILITIES	07/21/2021
DIRECTOR'S JOB RESPONSIBILITIES	07/27/2021
LICENSING ORIENTATION	07/26/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	08/31/2022
ANNUAL DECLARATION	08/31/2022

Inspection determined facility to be in compliance with licensing rules.

Open Violations: 1

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 5

Total Children 25

Staff	Child	Class Age	Note
1	0	NO CHILDREN IN ATTENDANCE	Staff: Diane Meehan (Director) Not counted in child/staff ratio.
2	11	SCHOOL AGE	Staff: Kim McClamroch and Zoe Collett. Age range 8 years through 10 years.
2	14	SCHOOL AGE	Staff: Melinda Colgrove and Jimmy Phillips. Age range 9 years through 11 years.

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

	Provider Comments
Violation The staff sheet was not fully completed as evidenced by the following was not listed: the Designee, the Board President, and employees that come to work on the school premises from the YMCA. Licensing Rule Reference 5 CSR 25-500.052 Annual Requirements (1) (D) states: A current staff sheet. Correction Required The facility shall submit a current staff sheet as required. Correction Verification Submit Documentation Compliance Date

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

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