DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

YMCA-SOUTH COUNTY BRANCH-BIERBAUM ELEMENTARY

000186338

(314) 467-5588

2050 UNION RD
ST LOUIS
MO  63125-3053

GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

12736 SOUTHFORK RD
ST LOUIS
MO  63128-3262

BOWMAN, MELISSA DAWN

melissa.bowman@gwrymca.org

Incorporated

MICHELLE (SHELLEY) TRUESDALE

5 YEARS - 12 YEARS

49

SCHOOL AGE

BEFORE AND AFTER SCHOOL CARE ONLY
 
Inspection Information

10/04/2022

3:45 PM

4:23 PM

UNANNOUNCED

COMPLIANCE MONITORING

2432232464


DocumentDocument-Date
SAMPLE WEEKLY MENU 09/13/1985
SAMPLE FORMS 09/13/1985
POLICIES 09/13/1985
LOCAL FIRE DEPARTMENT NOTIFICATION 09/13/2011
CERTIFICATE OF INCORPORATION 09/13/1985
LINES OF ADMINISTRATIVE AUTHORITY 09/13/1985
JOB RESPONSIBILITIES 09/13/1985
DISCIPLINE POLICIES 09/13/1985
DIRECTOR'S QUALIFICATIONS 12/13/2021
DIRECTOR'S JOB RESPONSIBILITIES 09/13/1985
DAILY SCHEDULE 09/13/1985
CHILD CARE PRACTICES 09/13/1985
CERTIFICATE OF GOOD STANDING 09/13/2011
ARTICLES OF INCORPORATION 09/13/1985
APPLICATION 10/24/2019
EQUIPMENT LIST 10/25/2019
STAFF SHEET 10/25/2019




Inspection determined facility to be in compliance with licensing rules.
Compliance Licensing Rules
Open Violations: 6
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 2
Total Children 16
StaffChildClass AgeNote
2 16 SCHOOL AGE Caregivers DF & MW present with children ages 5 - 10-years-old

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
Violation
 Provider Comments
Violation
The equipment list was not submitted.
Licensing Rule Reference
5 CSR 25-500.052 Annual Requirements (1) (C) states: A current list of available equipment.
Correction Required
The facility shall submit an equipment list as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The staff sheet was not submitted.
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

Violation
The Annual Declaration was not submitted.
Licensing Rule Reference
5 CSR 25-500.052 Annual Requirements (1) (A) states: An Annual Declaration for Licensed Facility form, revised 2021 and incorporated by reference in this rule. As published by the Missouri Department of Elementary and Secondary Education, PO Box 480, Jefferson City, MO 65102-0480 and available by the department at https://dese.mo.gov/childhood/forms, indicating the licensee’s intent to continue operating a licensed group child care home or child care center and agreement to comply with all statutes and department licensing rules.
Correction Required
The facility shall submit the Annual Declaration as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The Family Care Safety Registry check was not conducted for MB, DF, PR, & MW within thirty (30) days prior to the anniversary date.
Licensing Rule Reference
5 CSR 25-500.052 Annual Requirements (2) (C) states: The child care provider shall conduct a Family Care Safety Registry check for all child care staff members within thirty (30) days prior to the anniversary date as printed on the license.
Correction Required
Required Family Care Safety Registry checks shall be conducted for all child care staff member(s) within thirty (30) days prior to the anniversary date.

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
Violation
 Provider Comments
Violation
The requirements for obtaining 12 clock hours each calendar year were not met. For the calendar year of 2021, the staff listed need the following information: PR needs 12 clock hours.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (3) (A) states: The center director, group child care home provider, all other caregivers, and those volunteers who are counted in staff/child ratios shall obtain at least twelve (12) clock hours of child-care related training during each calendar year. Clock hour training shall be approved by the department.
Correction Required
Required training hours shall be documented for each caregiver.

Correction Verification
Submit Documentation

Compliance Date

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: DF.
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
Violation
 Provider Comments
Violation
The facility did not meet requirements for child enrollment and health information as evidenced by there was no signed authorization for emergency medical treatment for 1 child.
Licensing Rule Reference
5 CSR 25-500.132 Admission Policies and Procedures (8) (E) 4. states: Instructions for action to be taken if the parent(s) or physician designated by the parent(s) cannot be reached in an emergency and permission for emergency medical care;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Return Inspection

Compliance Date
10/4/2022
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
 Provider Comments
Violation
Requirements for immunization reports on file were not met as evidenced by 1 immunization record(s) was/were not on file .
Licensing Rule Reference
5 CSR 25-500.192 Health Care (4) (A) states: No child shall be permitted to enroll in or attend any day care facility caring for ten (10) or more children unless the child has been immunized adequately against vaccine preventable childhood illnesses specified by the department in accordance with recommendations of the Immunization Practices Advisory Committee (ACIP). The parent or guardian of the child shall provide satisfactory evidence of the required immunizations. Satisfactory evidence means a statement, certificate or record from a physician or other recognized health facility or personnel, stating that the required immunizations have been given to the child and verifying the type of vaccine and the month, day and year of administration.
Correction Required
Child immunization requirements shall be on file as required.

Correction Verification
Return Inspection

Compliance Date
10/4/2022
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