MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT

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Facility Information

Facility Name
JEFFERSON CITY AREA YOUNG MEN'S CHRISTIAN ASSOCIATION

Facility DVN
002603945

Phone
(573) 657-9600

Physical Address
300 E BROADWAY
ASHLAND
MO 65010-9305

Owner
JEFFERSON CITY AREA YOUNG MEN'S CHRISTIAN ASSOCIATION

Mailing Address
PO BOX 56
ASHLAND
MO 65010-0056

Provider/Director
KELTNER, NABRINA MARIE

E-mail Address
nabrinas@jcymca.org

Incorporated
Incorporated

Child Care Specialist
JOY LYNN NICHOLS

Age Range
5 YEARS - 12 YEARS

Capacity
46

Facility Type
GROUP HOME AND CENTER

Limitations

Inspection Information

Date
11/01/2022

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2434252247

Document	Document-Date
DAILY SCHEDULE	06/15/2018
SAMPLE WEEKLY MENU	06/15/2018
CHILD CARE PRACTICES	06/09/2018
DISCIPLINE POLICIES	06/09/2018
ARTICLES OF INCORPORATION	10/22/2018
LINES OF ADMINISTRATIVE AUTHORITY	06/15/2018
POLICIES	06/15/2018
REGISTERING FICTITIOUS NAMES	10/22/2018
LOCAL BUILDING APPROVAL	02/22/2019
DIAGRAM/OUTDOOR	10/23/2018
JOB RESPONSIBILITIES	06/15/2018
LOCAL FIRE DEPARTMENT NOTIFICATION	02/01/2019
LOCAL ZONING APPROVAL	02/22/2019
DISASTER AND EMERGENCY PREPAREDNESS PLAN	02/27/2019
APPLICATION	03/26/2019
STAFF SHEET	03/01/2019
CERTIFICATE OF GOOD STANDING	01/12/2021
DIRECTOR'S QUALIFICATIONS	09/28/2020
LICENSING ORIENTATION	06/09/2018
SAMPLE FORMS	10/02/2018
DIAGRAM/INDOOR	05/12/2021
SANITATION INSPECTION	01/04/2022
FIRE/SAFETY INSPECTION	02/07/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	03/02/2022
EQUIPMENT LIST	03/02/2022
ANNUAL DECLARATION	03/02/2022

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.

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 25-500.087 Fire Safety 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 25-500.142 Nighttime Care Compliance
5 CSR 25-500.162 Overlap Care of Children 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 Violation
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