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Deficiency Form (7) DHR-DFC-1926 ALABAMA DEPARTMENT OF HUMAN RESOURCES CHILD CARE MINIMUM STANDARDS DEFICIENCY REPORT SECTION A-IDENTIFYING INFORMATION Facility Name: Type of Facility: Home Date of Visit: B'S DAY CARE HOME Day ® Group Night ❑ Center ❑ Day/Night ❑ S.A.P ❑ month / day / year Facility Address: Licensee: Telephone#: 407 VOLANTA AVE BELINDA DOUGLAS (251)210-3753 FAIRHOPE,AL 36532 Ages: Director (if applicable): Capacity: 6 Weeks through 4 Years IV tR 6 - Day SECTION B -DEFICIENCY INFORMATION Column 1 Column 2 Minimum Standard Date Corrected by Deficiency Licensee Y ` INSTRUCTIONS TO LICENSEE: Column 2,Date Corrected by Licensee, is to be completed by the facility representative after each deficiency is corrected. The facility representative must put the date of correction and his/her initials in Column 2. This form must be returned to the Department of Human Resources on or before AZ(A , as verification that deficiencies have been corrected. NOTICE: Any misleading or any false statements or reports made to the Department and/or failure to correct the listed deficiencies can be the basis for adverse action. None of these requirements are to be interpreted to allow anyone to operate in violation of Minimum Standards. A facility licensed by the Department must meet Minimum Standards applicable to that facility at all times. It is the responsibility of the licensee to opera"i o pliance with Minimum Standards. Signature of Facility Representative 'e-'/Dat 7 Signature of DHR Licensing Representative Date COPIES TO: Page Llf