DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE GHC INSPECTION REPORT
Facility Information

YMCA-FOUR RIVERS BRANCH-CLEARVIEW ELEMENTARY

000434711

(314) 436-1177

1581 CLEARVIEW RD
UNION
MO  63084-3031

GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

400 GRAND AVE
WASHINGTON
MO  63090

MUELLER, MELISSA

melissa.mueller@gwrymca.org

Incorporated

KATHLEEN WILSON

5 YEARS - 12 YEARS

40

SCHOOL AGE GHC

BEFORE AND AFTER SCHOOL CARE ONLY
 
Inspection Information

05/12/2026

3:00 PM

3:30 PM

UNANNOUNCED

COMPLIANCE MONITORING

2513222623


DocumentDocument-Date
LINES OF ADMINISTRATIVE AUTHORITY 03/03/2007
CERTIFICATE OF INCORPORATION 02/06/2003
ARTICLES OF INCORPORATION 02/06/2003
SAMPLE WEEKLY MENU 03/03/2007
DAILY SCHEDULE 03/03/2007
POLICIES 02/17/2005
DISASTER AND EMERGENCY PREPAREDNESS PLAN 09/13/2018
STAFF SHEET 03/26/2019
APPLICATION 03/06/2019
DIRECTOR'S QUALIFICATIONS 10/13/2020
JOB RESPONSIBILITIES 03/03/2007
CHILD CARE PRACTICES 03/03/2007
CERTIFICATE OF GOOD STANDING 02/22/2021
REGISTERING FICTITIOUS NAMES 02/22/2021
DIRECTOR'S JOB RESPONSIBILITIES 02/10/2005
DISCIPLINE POLICIES 03/03/2007
DISASTER AND EMERGENCY PREPAREDNESS PLAN 05/12/2022
EQUIPMENT LIST 04/09/2025
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 04/09/2025
ANNUAL DECLARATION 04/09/2025




Inspection determined facility to be in compliance with licensing rules.
Compliance Licensing Rules
Open Violations: 1
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 17
StaffChildClass AgeNote
2 17 SCHOOL AGE Adam Vancil and Pyper Kiser with seventeen children ages 5 - 12 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
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
Violation
 Provider Comments
Violation
Medical examination report was not on file for Pyper Kiser 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

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
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