DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

TWIN PIKE FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.

001779419

(573) 754-5412

23526 PIKE 9247
LOUISIANA
MO  63353-4103

TWIN PIKE FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.

614 KELLY LN
LOUISIANA
MO  63353-2409

LOVELL, LESLIE ALANE

cassie.spangler@twinpikefamilyymca.org

Incorporated

SUSAN MARIE DOUGLAS

5 YEARS - 15 YEARS

32

SCHOOL AGE

 
Inspection Information

11/10/2022

3:05 PM

3:58 PM

UNANNOUNCED

COMPLIANCE MONITORING

2435348331


DocumentDocument-Date
SAMPLE FORMS 09/02/2003
DISCIPLINE POLICIES 09/02/2003
LINES OF ADMINISTRATIVE AUTHORITY 09/02/2003
DIRECTOR'S QUALIFICATIONS 08/02/2008
STAFF SHEET 09/16/2019
APPLICATION 08/21/2019
ANNUAL DECLARATION 09/27/2022
EQUIPMENT LIST 09/27/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 09/27/2022
CERTIFICATE OF INCORPORATION 10/29/2002
ARTICLES OF INCORPORATION 10/29/2002
POLICIES 09/02/2003
DIRECTOR'S JOB RESPONSIBILITIES 09/20/2005
DAILY SCHEDULE 09/21/2005
SAMPLE WEEKLY MENU 09/02/2003
CHILD CARE PRACTICES 07/01/2003
LOCAL FIRE DEPARTMENT NOTIFICATION 09/02/2003
CERTIFICATE OF GOOD STANDING 09/27/2022




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 3
Total Children 11
StaffChildClass AgeNote
3 11 SCHOOL AGE A.B. person in charge, M.T. staff and H.L. staff were present with 11 children ages 6 to 11.

 
5 CSR 25-500.032 Organization and Administration
Compliance
5 CSR 25-500.042 Licensing Process
Compliance
5 CSR 25-500.052 Annual Requirements
Violation
 Provider Comments
Violation
The Family Care Safety Registry check was not conducted for A.B., D.B., J.F., C.H-S. H.L. L.L., M.R. ,S.S., M.T. P.B, within thirty (30) days prior to the anniversary date.
Licensing Rule Reference
5 CSR 25-500.052 Annual Requirements (2) (C) states: The child care provider shall conduct a Family Care Safety Registry check for all child care staff members within thirty (30) days prior to the anniversary date as printed on the license.
Correction Required
Required Family Care Safety Registry checks shall be conducted for all child care staff member(s) within thirty (30) days prior to the anniversary date.

Correction Verification
Submit Documentation

Compliance Date

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
Violation
 Provider Comments
Violation
An individualized plan for specialized care for a child with special physical, developmental or behavioral needs was not on file.
Licensing Rule Reference
5 CSR 25-500.132 Admission Policies and Procedures (6) states: A child who has a special physical, developmental or behavioral need shall have on file an individualized plan for specialized care from a professionally qualified source.
Correction Required
An individualized plan from a professional source shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

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
 Provider Comments
Violation
1 child(ren) records did not include employers' address of parent(s), guardian or legal custodian.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
1 child(ren) records did not include name, address and telephone number of another individual who might be reached in an emergency.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (C) states: Name, address and telephone number of another individual (friend or relative) who might be reached in an emergency when the parent(s), guardian or legal custodian cannot be reached;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

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