MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
Y-CLUB @ LEWIS & CLARK MIDDLE SCHOOL

Facility DVN
002855567

Phone
(573) 659-3000

Physical Address
325 LEWIS AND CLARK DR
JEFFERSON CITY
MO 65101-5586

Owner
JEFFERSON CITY AREA YOUNG MEN'S CHRISTIAN ASSOCIATION

Mailing Address
PO BOX 104176
JEFFERSON CITY
MO 65110-4176

Provider/Director
KEVER, JESSICA RENEE

E-mail Address
jkever@jcymca.org

Incorporated
Incorporated

Child Care Specialist
LAUREN R RAYWARNKE

Age Range
11 YEARS - 14 YEARS

Capacity
60

Facility Type
SCHOOL AGE

Limitations
BEFORE SCHOOL CARE ONLY

Inspection Information

Date
08/25/2023

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2453283598

Document	Document-Date
APPLICATION	09/22/2020
REGISTERING FICTITIOUS NAMES	10/08/2020
SAMPLE FORMS	12/21/2020
ARTICLES OF INCORPORATION	12/21/2020
CERTIFICATE OF GOOD STANDING	12/21/2020
CERTIFICATE OF INCORPORATION	12/21/2020
DISCIPLINE POLICIES	12/21/2020
CHILD CARE PRACTICES	12/21/2020
POLICIES	12/21/2020
DIRECTOR'S QUALIFICATIONS	09/23/2020
DISASTER AND EMERGENCY PREPAREDNESS PLAN	01/06/2021
DAILY SCHEDULE	01/06/2021
LINES OF ADMINISTRATIVE AUTHORITY	01/06/2021
DIRECTOR'S JOB RESPONSIBILITIES	01/06/2021
JOB RESPONSIBILITIES	01/06/2021
LOCAL FIRE DEPARTMENT NOTIFICATION	02/04/2021
LICENSING ORIENTATION	10/05/2020
STAFF SHEET	03/03/2021
EQUIPMENT LIST	03/03/2023
ANNUAL DECLARATION	02/24/2023
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	02/24/2023

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.

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 Violation
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