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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: SUMTER CO. OPP., INC. EARLY HEAD Day Y Group Ell START Night ❑ Center ® / f 8 / '9 Day/Night ❑ S.A.P ❑ month / day / year Facility Address: Licensee: Telephone#: 714 COUNTRY CLUB ROAD SUMTER COUNTY (205)652-4477 LIVINGSTON,AL 35470 OPPORTUNITY, INC. Ages: Director(if applicable): Capacity: 0 Weeks through 3 Years LETHA MILLS 56 -Day SECTION B -DEFICIENCY INFORMATION Column I Column 2 Minimum Standard Date Corrected by Deficiency Licensee i n ee 2YM-Am ro om 4hare m hazw—dwus 8(4gkiae ql is jig ' k , cl x 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 R , as verification that deficiencies have been corrected. W e,C+ hazard 3- 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 t censee to ope to in complia a with Minimum St ndards. Signature of Facility Representat Dat t sl� Signature of DHR Licensing Representative Dat COPIES TO: D;rec ' Page of