MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
YMCA-FOUR RIVERS BRANCH-CLEARVIEW ELEMENTARY

Facility DVN
000434711

Phone
(314) 436-1177

Physical Address
1581 CLEARVIEW RD
UNION
MO 63084-3031

Owner
GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

Mailing Address
400 GRAND AVE
WASHINGTON
MO 63090

Provider/Director
PADO, CONNIE LOUISE

E-mail Address
melissa.mueller@gwrymca.org

Incorporated
Incorporated

Child Care Specialist
ALLA GERASIMOVA

Age Range
5 YEARS - 12 YEARS

Capacity
40

Facility Type
SCHOOL AGE

Limitations
BEFORE AND AFTER SCHOOL CARE ONLY

Inspection Information

Date
12/15/2022

Arrival Time
2:50 PM

Departure Time
3:25 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2437678944

Document	Document-Date
LINES OF ADMINISTRATIVE AUTHORITY	03/03/2007
CERTIFICATE OF INCORPORATION	02/06/2003
ARTICLES OF INCORPORATION	02/06/2003
SAMPLE WEEKLY MENU	03/03/2007
DAILY SCHEDULE	03/03/2007
POLICIES	02/17/2005
DISASTER AND EMERGENCY PREPAREDNESS PLAN	09/13/2018
STAFF SHEET	03/26/2019
APPLICATION	03/06/2019
DIRECTOR'S QUALIFICATIONS	10/13/2020
JOB RESPONSIBILITIES	03/03/2007
CHILD CARE PRACTICES	03/03/2007
EQUIPMENT LIST	05/06/2021
ANNUAL DECLARATION	02/22/2021
CERTIFICATE OF GOOD STANDING	02/22/2021
REGISTERING FICTITIOUS NAMES	02/22/2021
DIRECTOR'S JOB RESPONSIBILITIES	02/10/2005
DISCIPLINE POLICIES	03/03/2007
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	02/22/2021
ANNUAL DECLARATION	05/12/2022
EQUIPMENT LIST	05/12/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	05/12/2022
DISASTER AND EMERGENCY PREPAREDNESS PLAN	05/12/2022

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 2

Total Children 22

Staff	Child	Class Age	Note
2	22	SCHOOL AGE	GK and OB present with 22 children of school age.

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 Compliance
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