DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE GHC INSPECTION REPORT
Facility Information

NORTHSIDE YOUTH AND SENIOR SERVICE CENTER, INC.

000335720

(314) 723-3069

1224 S 14TH ST
ST LOUIS
MO  63104

NORTHSIDE YOUTH AND SENIOR SERVICE CENTER, INC.

4120 MAFFITT AVE
ST LOUIS
MO  63113

AVANT, DOMINIQUE ALVIN

davant@nsyssc.com

Incorporated

BRITTNEY RALPH

5 YEARS - 12 YEARS

50

SCHOOL AGE GHC

AFTER SCHOOL CARE ONLY
 
Inspection Information

04/23/2026

3:44 PM

4:43 PM

UNANNOUNCED

COMPLIANCE MONITORING

2512077300


DocumentDocument-Date
DIRECTOR'S JOB RESPONSIBILITIES 04/10/2007
DAILY SCHEDULE 04/10/2007
SAMPLE WEEKLY MENU 04/10/2007
SAMPLE FORMS 04/10/2007
POLICIES 04/10/2007
DISCIPLINE POLICIES 04/10/2007
LINES OF ADMINISTRATIVE AUTHORITY 04/10/2007
JOB RESPONSIBILITIES 04/10/2007
DIRECTOR'S QUALIFICATIONS 03/31/2015
ARTICLES OF INCORPORATION 03/16/2007
CHILD CARE PRACTICES 04/02/2007
STAFF SHEET 01/30/2017
APPLICATION 02/11/2019
EQUIPMENT LIST 04/01/2025
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 04/01/2025
ANNUAL DECLARATION 04/01/2024
DISASTER AND EMERGENCY PREPAREDNESS PLAN 04/04/2019




Inspection determined facility to be in compliance with licensing rules.
Compliance Licensing Rules
Open Violations: 7
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 5
Total Children 16
StaffChildClass AgeNote
2 6 SCHOOL AGE Staff members, Shyler Johnson and Uriyha Hearon were present with six children ages ranging between 5-years-old to 12-years-old.
2 10 SCHOOL AGE Staff members, Kai'lynn Taylor and Darrell Charles were present with ten children ages ranging between 5-years-old to 7-years-old.
1 0 SCHOOL AGE Director, Dominique Avant was present with zero 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
Violation
 Provider Comments
Violation
The Annual Declaration was not submitted.
Licensing Rule Reference
5 CSR 25-500.052 Annual Requirements (1) (A) states: An Annual Declaration for Licensed Facility form, revised 2021 and incorporated by reference in this rule. As published by the Missouri Department of Elementary and Secondary Education, PO Box 480, Jefferson City, MO 65102-0480 and available by the department at https://dese.mo.gov/childhood/forms, indicating the licensee’s intent to continue operating a licensed group child care home or child care center and agreement to comply with all statutes and department licensing rules.
Correction Required
The facility shall submit the Annual Declaration as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The staff sheet was not submitted.
Licensing Rule Reference
5 CSR 25-500.052 Annual Requirements (1) (D) states: A current staff sheet.
Correction Required
The facility shall submit a current staff sheet as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
The equipment list was not submitted.
Licensing Rule Reference
5 CSR 25-500.052 Annual Requirements (1) (C) states: A current list of available equipment.
Correction Required
The facility shall submit an equipment list as required.

Correction Verification
Submit Documentation

Compliance Date

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
Violation
 Provider Comments
Violation
A school-age child's health report was not on file at the time of enrollment as evidenced by one child's school age health report was not signed by the parent.
Licensing Rule Reference
5 CSR 25-500.122 Medical Examination Reports (2) (D) states: The parent(s) of a school-age child shall provide a report at the time of enrollment indicating the child's health history, any current health problems, and any restrictions necessary for the child's care.
Correction Required
Child medical requirements shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-500.132 Admission Policies and Procedures
Violation
 Provider Comments
Violation
An individualized plan for specialized care for a child with special physical, developmental or behavioral needs was not on file.
Licensing Rule Reference
5 CSR 25-500.132 Admission Policies and Procedures (6) states: A child who has a special physical, developmental or behavioral need shall have on file an individualized plan for specialized care from a professionally qualified source.
Correction Required
An individualized plan from a professional source shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-500.142 Nighttime Care
Compliance
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
Compliance
5 CSR 25-500.212 Transportation and Field Trips
Compliance
5 CSR 25-500.222 Records and Reports
Violation
 Provider Comments
Violation
1 child(ren) records did not include employers' address of parent(s), guardian or legal custodian.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-600.020 General Requirements
Violation
 Provider Comments
Violation
Criminal background check results were not on file for Darrell Charles.
Licensing Rule Reference
5 CSR 25-600.020 General Requirements (1) states: Prior to the employment or presence of a child care staff member in a licensed, regulated, or registered child care facility not exempted by section 210.1080.13, RSMo, the child care provider shall request the results of a criminal background check for such child care staff member from the department.
Correction Required
Required results of criminal background checks shall be on file.

Correction Verification
Submit Documentation

Compliance Date

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