DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

YMCA-SOUTH CITY BRANCH-ST. AMBROSE CATHOLIC SCHOOL

003019512

(314) 772-1437

5110 WILSON AVE
ST LOUIS
MO  63110-3110

GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

3150 SUBLETTE AVE
ST LOUIS
MO  63139-1467

DECLUE, CHRISTINA

christina.declue@gwrymca.org

Incorporated

AMY MUSSELMAN

5 YEARS - 13 YEARS

40

SCHOOL AGE

AFTER SCHOOL CARE ONLY
 
Inspection Information

08/24/2023

N/A

N/A

N/A

COMPLIANCE VERIFICATION

2453210673


DocumentDocument-Date
SAMPLE WEEKLY MENU 08/01/2023
SAMPLE FORMS 08/01/2023
POLICIES 08/01/2023
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 08/01/2023
LINES OF ADMINISTRATIVE AUTHORITY 08/01/2023
LICENSING ORIENTATION 02/13/2022
JOB RESPONSIBILITIES 08/01/2023
EQUIPMENT LIST 08/02/2023
DISCIPLINE POLICIES 08/01/2023
DIRECTOR'S QUALIFICATIONS 08/01/2023
DIRECTOR'S JOB RESPONSIBILITIES 08/01/2023
DAILY SCHEDULE 08/01/2023
CHILD CARE PRACTICES 08/01/2023
CERTIFICATE OF INCORPORATION 07/05/2023
ARTICLES OF INCORPORATION 07/05/2023
CERTIFICATE OF GOOD STANDING 07/05/2023
APPLICATION 07/05/2023
DISASTER AND EMERGENCY PREPAREDNESS PLAN 08/01/2023




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
Violation
 Provider Comments
Violation
Additional information is required to make a determination regarding licensure, specifically Fire Department Notification Form
Licensing Rule Reference
5 CSR 25-500.042 Licensing Process (4) (Q) states: Other information required by the department to make a determination regarding licensure of the facility.
Correction Required
The facility shall submit information as requested by the department.

Correction Verification
Submit Documentation

Compliance Date
8/15/2023
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
Violation
 Provider Comments
Violation
The requirements for first aid/CPR were not met as evidenced by there was no documentation on file showing completion of age-appropriate first aid certification for the requested/licensed capacity.
Licensing Rule Reference
5 CSR 25-500.102 Personnel (1) (T) states: The licensee shall have documentation on file at the facility of current certification in age-appropriate first aid and cardiopulmonary resuscitation (CPR) training for a sufficient number of child care staff to ensure that there is one (1) caregiver at the facility for every twenty (20) children in the licensed capacity. At least one (1) caregiver with current certification in age appropriate first aid and CPR must be on site at all times when children are present. The training shall be certified by a nationally-recognized organization, such as the American Red Cross, American Heart Association, or an equivalent certification, include an in-person skills assessment, and be [and] approved by the department.
Correction Required
Required age-appropriate certification in first aid/CPR shall be on file, with at least one caregiver with certification on site.

Correction Verification
Submit Documentation

Compliance Date
8/15/2023
5 CSR 25-500.112 Staff/Child Ratios
Compliance
5 CSR 25-500.122 Medical Examination Reports
Violation
 Provider Comments
Violation
Medical examination report was not on file for Maria Driver as evidenced by a medical examination was not on file at the facility at the time of initial licensure.
Licensing Rule Reference
5 CSR 25-500.122 Medical Examination Reports (1) (A) states: All persons working in a child care facility in any capacity during child care hours, including volunteers counted in staff/child ratios, shall be in good physical and emotional health with no physical or mental conditions which would interfere with child care responsibilities. These persons shall have a medical examination report, signed by a licensed physician or registered nurse who is under the supervision of a licensed physician, on file at the facility at the time of initial licensure or within thirty (30) days following employment.
Correction Required
Medical reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date
8/15/2023
Violation
A medical examination report did not include either a completed Risk Assessment for Tuberculosis form or a negative tuberculin skin test (TST) within 12 months of the individual's begin date at the facility for the following staff: Maria Driver.
Licensing Rule Reference
5 CSR 25-500.122 Medical Examination Reports (1) (B) . states: Medical examination reports shall include either a Tuberculosis (TB) Risk Assessment form, completed and signed by a health care professional, or a negative tuberculin skin test (TST) completed not more than twelve (12) months before beginning work in the facility. The Tuberculosis (TB) Risk Assessment form, revised March 2014, is incorporated by reference in this rule, as published by the Missouri Department of Health and Senior Services, PO Box 570, Jefferson City, MO 65102 and available by the Missouri Department of Health and Senior Services at https://health.mo.gov/living/healthcondiseases/communicable/tuberculosis/tbmanual/pdf/RiskAssessmentform.pdf. If the person has signs or symptoms of tuberculosis, or risk factors for tuberculosis, then testing for tuberculosis shall occur.
Correction Required
Medical examination reports shall include Risk Assessment for Tuberculosis forms or negative tuberulin skin test (TST) as required.

Correction Verification
Submit Documentation

Compliance Date
8/15/2023
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
Violation
 Provider Comments
Violation
Criminal background check results were not on file for Maria Driver.
Licensing Rule Reference
5 CSR 25-600.020 General Requirements (1) states: Prior to the employment or presence of a child care staff member in a licensed, regulated, or registered child care facility not exempted by section 210.1080.13, RSMo, the child care provider shall request the results of a criminal background check for such child care staff member from the department.
Correction Required
Required results of criminal background checks shall be on file.

Correction Verification
Submit Documentation

Compliance Date
8/15/2023
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