MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
TWIN PIKE FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.

Facility DVN
002064402

Phone
(573) 324-8461

Physical Address
700 W ADAMS ST
BOWLING GREEN
MO 63334-2046

Owner
TWIN PIKE FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.

Mailing Address
614 KELLY LN
LOUISIANA
MO 63353-2409

Provider/Director
ASH, DENISE MARIE

E-mail Address
cassie.spangler@twinpikefamilyymca.org

Incorporated
Incorporated

Child Care Specialist
SUSAN MARIE DOUGLAS

Age Range
5 YEARS - 13 YEARS

Capacity
120

Facility Type
SCHOOL AGE

Limitations

Inspection Information

Date
10/04/2023

Arrival Time
3:50 PM

Departure Time
4:50 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2456108764

Document	Document-Date
SAMPLE FORMS	09/04/2007
LINES OF ADMINISTRATIVE AUTHORITY	08/27/2007
LOCAL FIRE DEPARTMENT NOTIFICATION	09/04/2007
DIRECTOR'S JOB RESPONSIBILITIES	09/04/2007
DIRECTOR'S QUALIFICATIONS	11/18/2022
DAILY SCHEDULE	09/04/2007
CHILD CARE PRACTICES	10/02/2007
CERTIFICATE OF INCORPORATION	09/04/2007
ARTICLES OF INCORPORATION	09/04/2007
APPLICATION	02/14/2019
STAFF SHEET	04/08/2019
CERTIFICATE OF GOOD STANDING	04/26/2023
ANNUAL DECLARATION	04/26/2023
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	09/19/2023
EQUIPMENT LIST	04/26/2023

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 8

Total Children 53

Staff	Child	Class Age	Note
2	0	NO CHILDREN IN ATTENDANCE	Sheila Alsup staff and Pam Sweeney staff were present at the inspection.
1	8	SCHOOL AGE	Linda Arnold staff was present with 8 children ages 5 to 6
2	10	SCHOOL AGE	Kara Jockisch staff and Jordan Johnson staff were present with 10 children ages 6 to 7.
1	11	SCHOOL AGE	Daniel Welker staff was present at the inspection with 11 children ages 9 to 11.
1	14	SCHOOL AGE	Shelby St.Aubyn staff was present with 14 children ages 7 to 8.
1	10	SCHOOL AGE	Cameron Deatherage staff was present with 10 children ages 8 to 9.


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 Not Observed
5 CSR 25-500.112 Staff/Child Ratios Compliance
5 CSR 25-500.122 Medical Examination Reports Not Observed
5 CSR 25-500.132 Admission Policies and Procedures Not Observed
5 CSR 25-500.172 Emergency School Closings Not Observed
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 Not Observed
5 CSR 25-500.212 Transportation and Field Trips Not Observed
5 CSR 25-500.222 Records and Reports Not Observed
5 CSR 25-600.020 General Requirements Not Observed
5 CSR 25-600.040 Background Screening Findings Not Observed
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. — Not Observed
RSMo 210.211. License required - exceptions - written notice of licensure status, when. Compliance