MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
BOYS & GIRLS CLUBS OF GREATER ST. LOUIS - ADAMS PARK CLUB

Facility DVN
002068711

Phone
(314) 633-7900

Physical Address
4317 VISTA AVE
ST LOUIS
MO 63110

Owner
BOYS & GIRLS CLUBS OF GREATER ST. LOUIS, INC.

Mailing Address
2901 N GRAND BLVD
ST LOUIS
MO 63107-2608

Provider/Director
JEFFRIES, MARLA

E-mail Address
KEISHA@BGCSTL.ORG

Incorporated
Incorporated

Child Care Specialist
KATHERINE D SIMS

Age Range
5 YEARS - 16 YEARS

Capacity
256

Facility Type
SCHOOL AGE

Limitations

Inspection Information

Date
11/03/2022

Arrival Time
2:40 PM

Departure Time
4:13 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2434657077

Document	Document-Date
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	03/30/2022
SAMPLE WEEKLY MENU	02/28/2008
LINES OF ADMINISTRATIVE AUTHORITY	11/01/2007
JOB RESPONSIBILITIES	02/28/2008
DISCIPLINE POLICIES	02/28/2008
DIRECTOR'S QUALIFICATIONS	07/02/2012
DIRECTOR'S JOB RESPONSIBILITIES	02/28/2012
DAILY SCHEDULE	02/28/2008
CHILD CARE PRACTICES	02/28/2008
SAMPLE FORMS	02/28/2008
POLICIES	02/28/2008
CERTIFICATE OF INCORPORATION	11/01/2007
ARTICLES OF INCORPORATION	11/01/2007
CERTIFICATE OF GOOD STANDING	05/18/2018
EQUIPMENT LIST	03/30/2022
STAFF SHEET	08/21/2020
REGISTERING FICTITIOUS NAMES	07/02/2012
APPLICATION	05/04/2020
DISASTER AND EMERGENCY PREPAREDNESS PLAN	05/25/2018
ANNUAL DECLARATION	03/30/2022

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.

Attendance at Time of Inspection

Total Staff 7

Total Children 33

Staff	Child	Class Age	Note
7	33	SCHOOL AGE	Caregivers, AG, JBE, DHW,CSM, RH, TB, and SK, present with thirty-three children, ages 5-years-old to 16-years-old


5 CSR 25-500.032 Organization and Administration Compliance
5 CSR 25-500.042 Licensing Process Compliance
5 CSR 25-500.052 Annual Requirements Not Observed
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 Not Observed
5 CSR 25-500.112 Staff/Child Ratios Compliance
5 CSR 25-500.122 Medical Examination Reports Not Observed
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 Compliance
5 CSR 25-500.222 Records and Reports Not Observed
5 CSR 25-600.020 General Requirements Not Observed
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