MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
YMCA-KIRKWOOD BRANCH-MARK TWAIN ELEMENTARY

Facility DVN
001606828

Phone
(314) 962-0613

Physical Address
8636 LITZSINGER RD
ST LOUIS
MO 63144-2423

Owner
GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

Mailing Address
1900 URBAN DR
BRENTWOOD
MO 63144-1824

Provider/Director
KOZAK, JONATHAN JOSEPH

E-mail Address
jennifer.bergman@gwrymca.org

Incorporated
Incorporated

Child Care Specialist
TANISHA BELL

Age Range
5 YEARS - 12 YEARS

Capacity
48

Facility Type
SCHOOL AGE

Limitations
BEFORE AND AFTER SCHOOL CARE ONLY

Inspection Information

Date
10/20/2022

Arrival Time
4:02 PM

Departure Time
4:44 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2433548401

Document	Document-Date
SAMPLE WEEKLY MENU	08/28/2011
SAMPLE FORMS	08/28/2011
REGISTERING FICTITIOUS NAMES	06/02/2010
POLICIES	08/28/2011
LINES OF ADMINISTRATIVE AUTHORITY	08/28/2011
DISCIPLINE POLICIES	08/28/2011
DIRECTOR'S QUALIFICATIONS	02/25/2013
DIRECTOR'S JOB RESPONSIBILITIES	08/28/2011
DAILY SCHEDULE	08/28/2011
CHILD CARE PRACTICES	08/28/2011
CERTIFICATE OF INCORPORATION	08/28/2011
CERTIFICATE OF GOOD STANDING	03/09/2011
ARTICLES OF INCORPORATION	08/28/2011
JOB RESPONSIBILITIES	07/02/2001
DISASTER AND EMERGENCY PREPAREDNESS PLAN	09/26/2018
APPLICATION	04/03/2019
STAFF SHEET	04/19/2019
ANNUAL DECLARATION	02/16/2021
EQUIPMENT LIST	10/18/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	10/18/2021

Inspection determined facility to be in compliance with licensing rules.

Open Violations: 4

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 1

Total Children 10

Staff	Child	Class Age	Note
1	10	SCHOOL AGE	D.W. (Group Leader) was present with ten children, 5-years-old-8-years-old.

Compliance List
5 CSR 25-500.032 Organization and Administration Compliance
5 CSR 25-500.042 Licensing Process Violation
5 CSR 25-500.052 Annual Requirements Violation
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 Violation
5 CSR 25-500.092 Furniture, Equipment and Materials Compliance
5 CSR 25-500.102 Personnel Violation
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 Violation
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