MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
YMCA-JEFFERSON COUNTY BRANCH-PEVELY ELEMENTARY

Facility DVN
001012684

Phone
(314) 598-1568

Physical Address
30 MAIN ST
PEVELY
MO 63070

Owner
GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

Mailing Address
1303 YMCA DR
FESTUS
MO 63028

Provider/Director
HOLDINGHAUSEN, CYNTHIA LOUISE

E-mail Address
cindy.holdinghausen@gwrymca.org

Incorporated
Incorporated

Child Care Specialist
BRITTANY HECHT

Age Range
5 YEARS - 12 YEARS

Capacity
48

Facility Type
SCHOOL AGE

Limitations
BEFORE AND AFTER SCHOOL CARE ONLY

Inspection Information

Date
06/12/2024

Arrival Time
7:15 AM

Departure Time
7:54 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2472630474

Document	Document-Date
ARTICLES OF INCORPORATION	10/05/2006
LINES OF ADMINISTRATIVE AUTHORITY	08/19/1997
SAMPLE WEEKLY MENU	08/19/1997
SAMPLE FORMS	08/19/1997
JOB RESPONSIBILITIES	08/19/1997
CHILD CARE PRACTICES	08/19/1997
DAILY SCHEDULE	08/19/1997
POLICIES	08/19/1997
LOCAL FIRE DEPARTMENT NOTIFICATION	09/11/2013
REGISTERING FICTITIOUS NAMES	09/04/2013
CERTIFICATE OF GOOD STANDING	10/19/2015
DISASTER AND EMERGENCY PREPAREDNESS PLAN	04/11/2012
DIRECTOR'S JOB RESPONSIBILITIES	08/01/1997
DISCIPLINE POLICIES	08/19/1997
APPLICATION	10/11/2019
STAFF SHEET	10/24/2019
EQUIPMENT LIST	12/12/2023
ANNUAL DECLARATION	12/12/2023
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	12/12/2023

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 15

Staff	Child	Class Age	Note
3	15	SCHOOL AGE	Kristina Kemp & Jennifer Cox, Caregivers/Designated People in Charge Sheryl Herbert, Caregiver 15 - 5-10 Year Olds

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