MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

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

Facility DVN
001782674

Phone
(573) 242-3546

Physical Address
28176 HIGHWAY WW
CLARKSVILLE
MO 63336-2637

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

Mailing Address
614 KELLY LN
LOUISIANA
MO 63353-2409

Provider/Director
YATES, REBECCA A

E-mail Address
Noveta.Shepherd@twinpikefamilyymca.org

Incorporated
Incorporated

Child Care Specialist
SUSAN MARIE DOUGLAS

Age Range
5 YEARS - 13 YEARS

Capacity
96

Facility Type
SCHOOL AGE

Limitations

Inspection Information

Date
11/30/2022

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2436505320

Document	Document-Date
CERTIFICATE OF INCORPORATION	10/29/2003
DISCIPLINE POLICIES	09/02/2003
LINES OF ADMINISTRATIVE AUTHORITY	09/02/2003
DIRECTOR'S JOB RESPONSIBILITIES	09/20/2005
DIRECTOR'S QUALIFICATIONS	10/30/2007
ARTICLES OF INCORPORATION	10/29/2003
CHILD CARE PRACTICES	09/20/2005
SAMPLE WEEKLY MENU	09/10/2003
DAILY SCHEDULE	05/06/2008
POLICIES	09/20/2005
STAFF SHEET	09/20/2019
ANNUAL DECLARATION	10/03/2022
EQUIPMENT LIST	10/03/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	10/03/2022
LOCAL FIRE DEPARTMENT NOTIFICATION	10/06/2022
CERTIFICATE OF GOOD STANDING	10/06/2022

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 25-500.090 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 Violation
5 CSR 25-500.132 Admission Policies and Procedures 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 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