MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
UNLEASHING POTENTIAL

Facility DVN
002785302

Phone
(314) 601-4448

Physical Address
200 DAY DR
FERGUSON
MO 63135-2252

Owner
UNLEASHING POTENTIAL

Mailing Address
1000 N VANDEVENTER AVE
ST LOUIS
MO 63113-3435

Provider/Director
FUTRELL III, DANIEL

E-mail Address
ghampton@upstl.org

Incorporated
Incorporated

Child Care Specialist
THERESA ZEHNLE

Age Range
5 YEARS - 12 YEARS

Capacity
32

Facility Type
SCHOOL AGE

Limitations
BEFORE AND AFTER SCHOOL CARE ONLY

Inspection Information

Date
10/12/2022

Arrival Time
3:30 PM

Departure Time
4:36 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2432849026

Document	Document-Date
APPLICATION	08/12/2019
CERTIFICATE OF GOOD STANDING	07/15/2019
JOB RESPONSIBILITIES	07/15/2019
DAILY SCHEDULE	07/15/2019
DISASTER AND EMERGENCY PREPAREDNESS PLAN	07/15/2019
DISCIPLINE POLICIES	07/15/2019
LOCAL FIRE DEPARTMENT NOTIFICATION	08/19/2019
POLICIES	07/15/2019
SAMPLE WEEKLY MENU	07/15/2019
LINES OF ADMINISTRATIVE AUTHORITY	07/15/2019
EQUIPMENT LIST	03/05/2021
STAFF SHEET	03/05/2021
ANNUAL DECLARATION	03/05/2021

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 4

Total Children 17

Staff	Child	Class Age	Note
4	17	SCHOOL AGE	NN, Director, KS, Site Manager, AJ, Program Assistant, and JJ, Program Assistant were present with seventeen children ages 8-years-old to 11-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 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 Not Observed
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 Not Observed
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