MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT

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Facility Information

Facility Name
BOYS & GIRLS CLUBS OF GREATER ST. LOUIS - ADAMS PARK CLUB

Facility DVN
002068711

Phone
(314) 633-7900

Physical Address
4317 VISTA AVE
ST LOUIS
MO 63110

Owner
BOYS & GIRLS CLUBS OF GREATER ST. LOUIS, INC.

Mailing Address
2901 N GRAND BLVD
ST LOUIS
MO 63107-2608

Provider/Director
BASCOM, TERI

E-mail Address
KEISHA@BGCSTL.ORG

Incorporated
Incorporated

Child Care Specialist
SAMANTHA UPSHAW

Age Range
5 YEARS - 16 YEARS

Capacity
256

Facility Type
SCHOOL AGE

Limitations

Inspection Information

Date
08/05/2024

Arrival Time
N/A

Departure Time
N/A

Notice
N/A

Inspection Type
COMPLIANCE VERIFICATION

Inspection ID
2475445051

Document	Document-Date
SAMPLE WEEKLY MENU	02/28/2008
LINES OF ADMINISTRATIVE AUTHORITY	11/01/2007
JOB RESPONSIBILITIES	02/28/2008
DISCIPLINE POLICIES	02/28/2008
DIRECTOR'S JOB RESPONSIBILITIES	02/28/2012
DAILY SCHEDULE	02/28/2008
CHILD CARE PRACTICES	02/28/2008
SAMPLE FORMS	02/28/2008
POLICIES	02/28/2008
CERTIFICATE OF INCORPORATION	11/01/2007
ARTICLES OF INCORPORATION	11/01/2007
DISASTER AND EMERGENCY PREPAREDNESS PLAN	05/25/2018
APPLICATION	05/04/2020
STAFF SHEET	08/21/2020
DIRECTOR'S QUALIFICATIONS	05/03/2023
CERTIFICATE OF GOOD STANDING	05/03/2023
EQUIPMENT LIST	03/29/2024
REGISTERING FICTITIOUS NAMES	05/03/2023
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	03/29/2024
ANNUAL DECLARATION	03/29/2024

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.

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 Violation
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 25-500.172 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