MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

Back

Facility Information

Facility Name
Y-CLUB @ THOMAS JEFFERSON MIDDLE SCHOOL

Facility DVN
002782878

Phone
(573) 659-3250

Physical Address
1201 FAIRGROUNDS RD
JEFFERSON CITY
MO 65109-5445

Owner
JEFFERSON CITY AREA YOUNG MEN'S CHRISTIAN ASSOCIATION

Mailing Address
PO BOX 104176
JEFFERSON CITY
MO 65110-4176

Provider/Director
WILLIAMS, DESTINY

E-mail Address
bwatkins@jcymca.org

Incorporated
Incorporated

Child Care Specialist
KATHLEEN WILSON

Age Range
11 YEARS - 14 YEARS

Capacity
60

Facility Type
SCHOOL AGE

Limitations
BEFORE SCHOOL CARE ONLY

Inspection Information

Date
11/28/2023

Arrival Time
7:37 AM

Departure Time
7:40 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2459649868

Document	Document-Date
EQUIPMENT LIST	03/23/2023
ANNUAL DECLARATION	03/23/2023
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	03/23/2023

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 19

Staff	Child	Class Age	Note
3	19	SCHOOL AGE	Director Destiny Williams, Destiny Stilley, Kelly Black with eighteen children ages 11-14 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