MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
YMCA-O'FALLON BRANCH-J.L. MUDD ELEMENTARY

Facility DVN
000172414

Phone
(314) 471-1242

Physical Address
610 PRINCE RUPPERT DR
O FALLON
MO 63366-1802

Owner
GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

Mailing Address
3451 PHEASANT MEADOW DR
O FALLON
MO 63368-7324

Provider/Director
YOUNG, BRADY

E-mail Address
courtney.stevenson@gwrymca.org

Incorporated
Incorporated

Child Care Specialist
AMY MUSSELMAN

Age Range
5 YEARS - 12 YEARS

Capacity
48

Facility Type
SCHOOL AGE

Limitations
BEFORE AND AFTER SCHOOL CARE ONLY

Inspection Information

Date
09/12/2023

Arrival Time
7:55 AM

Departure Time
8:23 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2454321741

Document	Document-Date
SAMPLE FORMS	05/15/1992
CERTIFICATE OF GOOD STANDING	03/29/2023
ARTICLES OF INCORPORATION	11/04/2014
CERTIFICATE OF INCORPORATION	11/04/2014
REGISTERING FICTITIOUS NAMES	11/04/2014
CHILD CARE PRACTICES	11/17/2014
DAILY SCHEDULE	11/17/2014
DISCIPLINE POLICIES	11/17/2014
JOB RESPONSIBILITIES	11/17/2014
LINES OF ADMINISTRATIVE AUTHORITY	11/17/2014
DIRECTOR'S JOB RESPONSIBILITIES	11/17/2014
SAMPLE WEEKLY MENU	11/17/2014
POLICIES	11/17/2014
OWNER/PROVIDER REFERENCES	11/17/2014
LOCAL FIRE DEPARTMENT NOTIFICATION	11/17/2014
APPLICATION	11/20/2018
DIRECTOR'S QUALIFICATIONS	02/05/2016
EQUIPMENT LIST	03/17/2023
STAFF SHEET	12/29/2020
ANNUAL DECLARATION	03/17/2023
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	03/17/2023

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.

Attendance at Time of Inspection

Total Staff 3

Total Children 25

Staff	Child	Class Age	Note
3	25	SCHOOL AGE	Jeremiah Roever, Site Director, Mary Judy Podhorn, Group Leader, and Rachel Sprague, substitute, were in attendance with twenty-five children, ages 5-years-old to 10-years-old.

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