MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
Y-CLUB @ THOMAS JEFFERSON MIDDLE SCHOOL

Facility DVN
002782878

Phone
(573) 659-3250

Physical Address
1201 FAIRGROUNDS RD
JEFFERSON CITY
MO 65109-5445

Owner
JEFFERSON CITY AREA YOUNG MEN'S CHRISTIAN ASSOCIATION

Mailing Address
PO BOX 104176
JEFFERSON CITY
MO 65110-4176

Provider/Director
WILLIAMS, DESTINY

E-mail Address
jkever@jcymca.org

Incorporated
Incorporated

Child Care Specialist
LAUREN R RAYWARNKE

Age Range
11 YEARS - 14 YEARS

Capacity
60

Facility Type
SCHOOL AGE

Limitations
BEFORE SCHOOL CARE ONLY

Inspection Information

Date
11/03/2022

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2434483757

Document	Document-Date
APPLICATION	07/30/2019
ARTICLES OF INCORPORATION	07/15/2019
REGISTERING FICTITIOUS NAMES	07/25/2019
CERTIFICATE OF GOOD STANDING	07/25/2019
DISCIPLINE POLICIES	07/25/2019
DISASTER AND EMERGENCY PREPAREDNESS PLAN	07/25/2019
DAILY SCHEDULE	07/25/2019
LINES OF ADMINISTRATIVE AUTHORITY	07/25/2019
SAMPLE FORMS	07/25/2019
POLICIES	07/25/2019
STAFF SHEET	08/13/2019
LOCAL FIRE DEPARTMENT NOTIFICATION	08/13/2019
JOB RESPONSIBILITIES	08/13/2019
CHILD CARE PRACTICES	08/13/2019
DIRECTOR'S JOB RESPONSIBILITIES	08/13/2019
CERTIFICATE OF INCORPORATION	07/25/2019
DIRECTOR'S QUALIFICATIONS	08/26/2019
EQUIPMENT LIST	03/18/2022
ANNUAL DECLARATION	03/18/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	03/18/2022

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.