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-WASHINGTON WEST ELEMENTARY

Facility DVN
001178345

Phone
(636) 239-5704

Physical Address
1570 W FIFTH ST
WASHINGTON
MO 63090

Owner
GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

Mailing Address
400 GRAND AVE
WASHINGTON
MO 63090-1204

Provider/Director
MURPHY, KAITLYNN IRENE

E-mail Address
melissa.mueller@gwrymca.org

Incorporated
Incorporated

Child Care Specialist
ALLA GERASIMOVA

Age Range
5 YEARS - 12 YEARS

Capacity
48

Facility Type
SCHOOL AGE

Limitations
BEFORE AND AFTER SCHOOL CARE ONLY

Inspection Information

Date
12/15/2022

Arrival Time
3:50 PM

Departure Time
4:14 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2437678952

Document	Document-Date
LINES OF ADMINISTRATIVE AUTHORITY	02/11/2008
JOB RESPONSIBILITIES	08/13/1998
LOCAL FIRE DEPARTMENT NOTIFICATION	02/28/2008
CHILD CARE PRACTICES	08/13/1998
SAMPLE WEEKLY MENU	01/23/2006
DAILY SCHEDULE	01/23/2006
POLICIES	06/22/2000
CERTIFICATE OF INCORPORATION	08/13/1998
ARTICLES OF INCORPORATION	08/13/1998
DISASTER AND EMERGENCY PREPAREDNESS PLAN	08/15/2018
STAFF SHEET	02/07/2020
APPLICATION	01/30/2020
DISCIPLINE POLICIES	06/22/2000
DIRECTOR'S JOB RESPONSIBILITIES	08/13/1998
ANNUAL DECLARATION	03/09/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	03/09/2021
CERTIFICATE OF GOOD STANDING	03/09/2021
EQUIPMENT LIST	05/06/2021
REGISTERING FICTITIOUS NAMES	03/09/2021
DIRECTOR'S QUALIFICATIONS	08/18/2021
ANNUAL DECLARATION	04/08/2022
EQUIPMENT LIST	04/08/2022
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	04/08/2022

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	FG and SD are present with 22 children of school age


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