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.

001779428

(573) 754-6904

500 HALEY AVE
LOUISIANA
MO  63353-2417

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

614 KELLY LN
LOUISIANA
MO  63353-2409

PEDERSEN, TERESA LEE

Noveta.Shepherd@twinpikefamilyymca.org

Incorporated

SUSAN MARIE DOUGLAS

5 YEARS - 13 YEARS

96

SCHOOL AGE

 
Inspection Information

11/28/2022

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2435623042


DocumentDocument-Date
SAMPLE FORMS 11/09/2022
LINES OF ADMINISTRATIVE AUTHORITY 08/27/2007
POLICIES 09/05/2003
SAMPLE WEEKLY MENU 09/05/2003
DAILY SCHEDULE 06/01/2004
CERTIFICATE OF GOOD STANDING 10/06/2022
DIRECTOR'S QUALIFICATIONS 09/24/2013
APPLICATION 08/22/2019
STAFF SHEET 09/19/2019
CHILD CARE PRACTICES 07/10/2003
DISCIPLINE POLICIES 09/05/2003
DIRECTOR'S JOB RESPONSIBILITIES 09/20/2005
ARTICLES OF INCORPORATION 10/29/2002
LOCAL FIRE DEPARTMENT NOTIFICATION 10/03/2022
JOB RESPONSIBILITIES 07/10/2003
CERTIFICATE OF INCORPORATION 10/29/2003
ANNUAL DECLARATION 10/03/2022
EQUIPMENT LIST 10/03/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 10/03/2022




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.

 
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 25-500.090 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
11/28/2022
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
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