MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
INDEPENDENCE 30 SCHOOL DISTRICT

Facility DVN
002310690

Phone
(816) 521-5513

Physical Address
2611 S LEES SUMMIT RD
INDEPENDENCE
MO 64055-1940

Owner
INDEPENDENCE 30 SCHOOL DISTRICT

Mailing Address
201 N FOREST AVE
INDEPENDENCE
MO 64050-2513

Provider/Director
HAYES, JORDAN HAYES

E-mail Address
YOUTH_DEVELOPMENT@ISDSCHOOLS.ORG

Incorporated

Child Care Specialist
JANA BARTON

Age Range
5 YEARS - 11 YEARS

Capacity
60

Facility Type
SCHOOL AGE

Limitations

Inspection Information

Date
02/07/2024

Arrival Time
4:45 PM

Departure Time
5:36 PM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2463304889

Document	Document-Date
STAFF SHEET	02/22/2021
DIRECTOR'S QUALIFICATIONS	05/15/2017
DIRECTOR'S JOB RESPONSIBILITIES	01/06/2012
JOB RESPONSIBILITIES	01/06/2012
CHILD CARE PRACTICES	01/06/2012
DISCIPLINE POLICIES	01/06/2012
LINES OF ADMINISTRATIVE AUTHORITY	01/06/2012
DAILY SCHEDULE	01/06/2012
POLICIES	01/06/2012
SAMPLE FORMS	01/06/2012
SAMPLE WEEKLY MENU	01/06/2012
APPLICATION	09/27/2019
ANNUAL DECLARATION	01/03/2024
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	01/03/2024
EQUIPMENT LIST	01/03/2024

Inspection determined facility to be in compliance with licensing rules.

Open Violations: 3

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
1	0	NO CHILDREN IN ATTENDANCE	Director Jordan Booze
1	10	SCHOOL AGE	with Catherine Gitlin
1	9	SCHOOL AGE	with Tory Douglas