DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE GHC INSPECTION REPORT
Facility Information

TWIN PIKE FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.

002064359

(573) 754-4497

500 SCHOOL ST
FRANKFORD
MO  63441-1019

TWIN PIKE FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.

614 KELLY LN
LOUISIANA
MO  63353-2409

GILBERT, ALICIA R

Ashley.Chamberlain@twinpikefamilyymca.org

Incorporated

AMY MITCHELL

5 YEARS - 13 YEARS

20

SCHOOL AGE GHC

 
Inspection Information

05/05/2026

4:14 PM

4:43 PM

UNANNOUNCED

COMPLIANCE MONITORING

2512710306


DocumentDocument-Date
SAMPLE FORMS 09/05/2007
POLICIES 10/01/2007
LOCAL FIRE DEPARTMENT NOTIFICATION 09/05/2007
LINES OF ADMINISTRATIVE AUTHORITY 09/05/2007
JOB RESPONSIBILITIES 09/05/2007
SAMPLE WEEKLY MENU 09/05/2007
DISCIPLINE POLICIES 10/01/2007
DIRECTOR'S JOB RESPONSIBILITIES 09/05/2007
DAILY SCHEDULE 09/05/2007
CHILD CARE PRACTICES 10/01/2007
CERTIFICATE OF INCORPORATION 09/05/2007
ARTICLES OF INCORPORATION 09/05/2007
APPLICATION 02/14/2019
CERTIFICATE OF GOOD STANDING 04/17/2024
DISASTER AND EMERGENCY PREPAREDNESS PLAN 05/01/2024
DIRECTOR'S QUALIFICATIONS 11/20/2024
ANNUAL DECLARATION 04/02/2025
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 04/18/2025
EQUIPMENT LIST 04/25/2025




Inspection determined facility to be in compliance with licensing rules.
Compliance Licensing Rules
Open Violations: 8
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 10
StaffChildClass AgeNote
2 10 SCHOOL AGE Alicia Gilbert (director) and Kathryn Miller were in attendance with 10 children ages 5-years-old through 10-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
 Provider Comments
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

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 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 Family Care Safety Registry check was not conducted for Cameron Deatherage, Alicia Gilbert and Kathryn Miller within thirty (30) days prior to the anniversary date.
Licensing Rule Reference
5 CSR 25-500.052 Annual Requirements (2) (C) states: The child care provider shall conduct a Family Care Safety Registry check for all child care staff members within thirty (30) days prior to the anniversary date as printed on the license.
Correction Required
Required Family Care Safety Registry checks shall be conducted for all child care staff member(s) within thirty (30) days prior to the anniversary date.

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
Violation
 Provider Comments
Violation
A facility orientation was not conducted for a caregiver(s) before being left alone with children. The following staff need a facility orientation: Cameron Deatherage, and Alicia Gilbert
Licensing Rule Reference
5 CSR 25-500.102 Personnel (1) (K) . states: The child care provider shall ensure that within seven (7) days of employment or volunteering, and before being left alone with children, that caregivers employed on or after August 30, 2019, receive a facility orientation. The facility orientation shall include--
Correction Required
The facility shall ensure that a facility orientation occurs within 7 days of employment or volunteering and before caregivers are left alone with children.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-500.112 Staff/Child Ratios
Compliance
5 CSR 25-500.122 Medical Examination Reports
Violation
 Provider Comments
Violation
Medical examination report was not on file for Cameron Deatherage, Alicia Gilbert and Kathryn Miller as evidenced by a medical examination was not on file within 30 days of an individual beginning to work with children.
Licensing Rule Reference
5 CSR 25-500.122 Medical Examination Reports (1) (A) states: All persons working in a child care facility in any capacity during child care hours, including volunteers counted in staff/child ratios, shall be in good physical and emotional health with no physical or mental conditions which would interfere with child care responsibilities. These persons shall have a medical examination report, signed by a licensed physician or registered nurse who is under the supervision of a licensed physician, on file at the facility at the time of initial licensure or within thirty (30) days following employment.
Correction Required
Medical reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
A medical examination report did not include either a completed Risk Assessment for Tuberculosis form or a negative tuberculin skin test (TST) within 12 months of the individual's begin date at the facility for the following staff: Cameron Deatherage, Alicia Gilbert and Kathryn Miller.
Licensing Rule Reference
5 CSR 25-500.122 Medical Examination Reports (1) (B) . states: Medical examination reports shall include either a Tuberculosis (TB) Risk Assessment form, completed and signed by a health care professional, or a negative tuberculin skin test (TST) completed not more than twelve (12) months before beginning work in the facility. The Tuberculosis (TB) Risk Assessment form, revised March 2014, is incorporated by reference in this rule, as published by the Missouri Department of Health and Senior Services, PO Box 570, Jefferson City, MO 65102 and available by the Missouri Department of Health and Senior Services at https://health.mo.gov/living/healthcondiseases/communicable/tuberculosis/tbmanual/pdf/RiskAssessmentform.pdf. If the person has signs or symptoms of tuberculosis, or risk factors for tuberculosis, then testing for tuberculosis shall occur.
Correction Required
Medical examination reports shall include Risk Assessment for Tuberculosis forms or negative tuberulin skin test (TST) as required.

Correction Verification
Submit Documentation

Compliance Date

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 25-500.162 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
Not Observed
5 CSR 25-500.222 Records and Reports
Compliance
5 CSR 25-600.020 General Requirements
Violation
 Provider Comments
Violation
Criminal background check results were older than five (5) years for Cameron Deatherage, Alicia Gilbert and Kathryn Miller.
Licensing Rule Reference
5 CSR 25-600.020 General Requirements (5) states: Criminal background checks shall be completed for each child care staff member every five (5) years.
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
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. —
Not Observed
RSMo 210.211.  License required - exceptions - written notice of licensure status, when.
Not Observed