MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

GROUP HOME AND CENTER INSPECTION REPORT

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Facility Information

Facility Name
TRI-STATE FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION

Facility DVN
002942669

Phone
(417) 427-3249

Physical Address
4709 CHOUTEAU DR
NEOSHO
MO 64850-9123

Owner
TRI-STATE FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION

Mailing Address
4701 CHOUTEAU DR
NEOSHO
MO 64850-9123

Provider/Director
FERGUSON, TINA RAE

E-mail Address
tina@tristatefamilyymca.org

Incorporated
Incorporated

Child Care Specialist
ANGEL DONSON

Age Range
5 YEARS - 13 YEARS

Capacity
64

Facility Type
GROUP HOME AND CENTER

Limitations

Inspection Information

Date
03/20/2024

Arrival Time
10:40 AM

Departure Time
11:43 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2466730545

Document	Document-Date
APPLICATION	01/27/2022
CERTIFICATE OF GOOD STANDING	03/25/2022
CHILD CARE PRACTICES	03/25/2022
DAILY SCHEDULE	03/25/2022
DIAGRAM/INDOOR	03/25/2022
DIAGRAM/OUTDOOR	06/09/2022
DIRECTOR'S QUALIFICATIONS	06/09/2022
DISASTER AND EMERGENCY PREPAREDNESS PLAN	03/25/2022
DISCIPLINE POLICIES	03/25/2022
JOB RESPONSIBILITIES	03/25/2022
POLICIES	03/25/2022
SAMPLE WEEKLY MENU	03/25/2022
LINES OF ADMINISTRATIVE AUTHORITY	06/09/2022
LOCAL BUILDING APPROVAL	06/14/2022
LOCAL FIRE DEPARTMENT NOTIFICATION	06/14/2022
LOCAL ZONING APPROVAL	06/14/2022
FIRE/SAFETY INSPECTION	02/08/2024
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	02/27/2024
EQUIPMENT LIST	02/27/2024
ANNUAL DECLARATION	02/27/2024

Inspection determined facility to be in compliance with licensing rules.

Open Violations: 2

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 23

Staff	Child	Class Age	Note
1	12	SCHOOL AGE	Misty Renfro with 12 children ages 5-12 years old.
1	11	SCHOOL AGE	Sara Kreis with 11 children ages 5-12 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 Violation
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers Compliance
5 CSR 25-500.087 Fire Safety 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
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 25-500.142 Nighttime Care Compliance
5 CSR 25-500.162 Overlap Care of Children 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