MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE GHC INSPECTION REPORT

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Facility Information

Facility Name
INDEPENDENCE 30 SCHOOL DISTRICT

Facility DVN
002301075

Phone
(816) 521-5398

Physical Address
17302 E R D MIZE RD
INDEPENDENCE
MO 64057-1819

Owner
INDEPENDENCE 30 SCHOOL DISTRICT

Mailing Address
201 N FOREST AVE
INDEPENDENCE
MO 64050-2513

Provider/Director
LUKOWSKI, KATELYN

E-mail Address
YOUTH_DEVELOPMENT@ISDSCHOOLS.ORG

Incorporated

Child Care Specialist
RACHEL CATRELL

Age Range
5 YEARS - 12 YEARS

Capacity
60

Facility Type
SCHOOL AGE GHC

Limitations
BEFORE AND AFTER SCHOOL CARE ONLY

Inspection Information

Date
04/30/2025

Arrival Time
7:46 AM

Departure Time
8:12 AM

Notice
UNANNOUNCED

Inspection Type
COMPLIANCE MONITORING

Inspection ID
2492249533

Document	Document-Date
JOB RESPONSIBILITIES	11/04/2011
LINES OF ADMINISTRATIVE AUTHORITY	11/04/2011
DIRECTOR'S QUALIFICATIONS	08/24/2011
CHILD CARE PRACTICES	11/04/2011
SAMPLE WEEKLY MENU	11/04/2011
DAILY SCHEDULE	11/04/2011
POLICIES	11/04/2011
DIAGRAM/INDOOR	11/04/2011
APPLICATION	07/11/2019
STAFF SHEET	10/05/2023
EQUIPMENT LIST	09/30/2024
ANNUAL DECLARATION	09/30/2024
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	09/30/2024

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.

Attendance at Time of Inspection

Total Staff 4

Total Children 30

Staff	Child	Class Age	Note
1	0	NO CHILDREN IN ATTENDANCE	Director Katelyn Lukowski with 0 children in attendance.
1	11	SCHOOL AGE	Caregiver Elijah Brock with 11 school aged children.
1	9	SCHOOL AGE	Caregiver Anngie Rausseo with 9 school aged children in attendance on the playground.
1	10	SCHOOL AGE	Caregiver Autumn Handley with 10 school aged children in attendance.

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 Not Observed
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 Not Observed
5 CSR 25-500.132 Admission Policies and Procedures Compliance
5 CSR 25-500.142 Nighttime Care Not Observed
5 CSR 25-500.162 Overlap Care of Children Compliance
5 CSR 25-500.162 Overlap Care of Children Compliance
5 CSR 25-500.172 Emergency School Closings Not Observed
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 Not Observed
5 CSR 25-500.212 Transportation and Field Trips Not Observed
5 CSR 25-500.222 Records and Reports Not Observed
5 CSR 25-600.020 General Requirements Compliance
5 CSR 25-600.040 Background Screening Findings Not Observed
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