DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

YMCA-SOUTH CITY BRANCH-BAYLESS ELEMENTARY

002016875

(314) 256-8608

4531 WEBER RD
ST LOUIS
MO  63123-5700

GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

3150 SUBLETTE AVE
ST LOUIS
MO  63139-1467

ROE, CHERYL

christina.declue@gwrymca.org

Incorporated

THERESA ZEHNLE

5 YEARS - 12 YEARS

40

SCHOOL AGE

BEFORE AND AFTER SCHOOL CARE ONLY
 
Inspection Information

10/26/2023

7:15 AM

8:02 AM

UNANNOUNCED

COMPLIANCE MONITORING

2457551751


DocumentDocument-Date
SAMPLE FORMS 08/16/2007
DIRECTOR'S QUALIFICATIONS 11/04/2008
POLICIES 08/16/2007
LOCAL FIRE DEPARTMENT NOTIFICATION 08/16/2007
LINES OF ADMINISTRATIVE AUTHORITY 08/16/2007
DIAGRAM/OUTDOOR 08/24/2007
DAILY SCHEDULE 08/24/2007
SAMPLE WEEKLY MENU 08/16/2007
LOCAL ZONING APPROVAL 09/26/2007
LOCAL BUILDING APPROVAL 09/26/2007
JOB RESPONSIBILITIES 08/16/2007
DIAGRAM/INDOOR 09/17/2007
CHILD CARE PRACTICES 08/16/2007
ARTICLES OF INCORPORATION 09/13/2011
FIRE/SAFETY INSPECTION 12/29/2014
SANITATION INSPECTION 11/03/2014
CERTIFICATE OF GOOD STANDING 10/13/2016
REGISTERING FICTITIOUS NAMES 10/13/2016
DIRECTOR'S JOB RESPONSIBILITIES 08/16/2007
DISASTER AND EMERGENCY PREPAREDNESS PLAN 06/07/2012
DISCIPLINE POLICIES 08/16/2007
APPLICATION 10/04/2018
STAFF SHEET 10/09/2018
EQUIPMENT LIST 09/29/2023
ANNUAL DECLARATION 09/29/2023




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 5
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 25
StaffChildClass AgeNote
2 25 SCHOOL AGE Ashley Holbrook, Group Leader, and Tyrah Seyss, Group Leader, were present with twenty-five children ages 5-years-old to 10-years-old

 
5 CSR 25-500.032 Organization and Administration
Compliance
5 CSR 25-500.042 Licensing Process
Compliance
5 CSR 25-500.052 Annual Requirements
Violation
 Provider Comments
Violation
The staff sheet was not submitted.
Licensing Rule Reference
5 CSR 25-500.052 Annual Requirements (1) (D) states: A current staff sheet.
Correction Required
The facility shall submit a current staff sheet as required.

Correction Verification
Submit Documentation

Compliance Date

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
A facility orientation was not conducted for a caregiver(s) before being left alone with children. The following staff need a facility orientation: Tyrah Seyss and Ashley Holbrook
Licensing Rule Reference
5 CSR 25-500.102 Personnel (1) (K) . states: The child care provider shall ensure that within seven (7) days of employment or volunteering, and before being left alone with children, that caregivers employed on or after August 30, 2019, receive a facility orientation. The facility orientation shall include:
Correction Required
The facility shall ensure that a facility orientation occurs within 7 days of employment or volunteering and before caregivers are left alone with children.

Correction Verification
Submit Documentation

Compliance Date

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 Tyrah Seyss and Ashley Holbrook as evidenced by a medical examination was not on file within 30 days of an individual beginning to work with children.
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

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: Tyrah Seyss and Ashley Holbrook.
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

5 CSR 25-500.132 Admission Policies and Procedures
Compliance
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
Compliance
5 CSR 25-500.212 Transportation and Field Trips
Not Observed
5 CSR 25-500.222 Records and Reports
Violation
 Provider Comments
Violation
The provider failed to maintain accurate records to meet administrative requirements as evidenced by Two staff members, Ashley Holbrook and Tyrah Seyss, were not in the MOPD System for this location.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (1) states: The child care provider shall maintain accurate records to meet administrative requirements and to ensure knowledge of the individual needs of children and their families.
Correction Required
Accurate records shall be maintained.

Correction Verification
Submit Documentation

Compliance Date

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