MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
INDEPENDENCE 30 SCHOOL DISTRICT

Facility DVN
002301057

Phone
(816) 521-5478

Physical Address
4300 S PHELPS RD
INDEPENDENCE
MO 64055-5102

Owner
INDEPENDENCE 30 SCHOOL DISTRICT

Mailing Address
201 N FOREST AVE
INDEPENDENCE
MO 64050-2513

Provider/Director
MAVERICK, MOSES

E-mail Address
YOUTH_DEVELOPMENT@ISDSCHOOLS.ORG

Incorporated
Incorporated

Child Care Specialist
JANA BARTON

Age Range
5 YEARS - 11 YEARS

Capacity
60

Facility Type
SCHOOL AGE

Limitations
BEFORE AND AFTER SCHOOL CARE ONLY

Inspection Information

Date
10/06/2022

Arrival Time
3:25 PM

Departure Time
4:18 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2432447888

Document	Document-Date
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	09/14/2022
EQUIPMENT LIST	09/14/2022
ANNUAL DECLARATION	09/14/2022
SAMPLE WEEKLY MENU	10/17/2011
POLICIES	10/17/2011
JOB RESPONSIBILITIES	10/17/2011
DISCIPLINE POLICIES	10/17/2011
DIRECTOR'S JOB RESPONSIBILITIES	10/17/2011
CHILD CARE PRACTICES	10/17/2011
SAMPLE FORMS	10/17/2011
LINES OF ADMINISTRATIVE AUTHORITY	10/17/2011
DAILY SCHEDULE	10/17/2011
DIRECTOR'S QUALIFICATIONS	08/24/2015
APPLICATION	08/01/2019
STAFF SHEET	08/21/2019

Inspection determined facility to be in compliance with licensing rules.

Open Violations: NA

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 19

Staff	Child	Class Age	Note
2	19	SCHOOL AGE	staff AR and MM


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 25-500.090 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