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HomeMy WebLinkAboutDeficiency Form (2) 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: ADVENTUROUS BEGINNINGS, INC. Day ❑x Group ❑ Night ❑ Center ® 2L / / Day/Night ❑ S.A.P ❑ —month / day / year� Facility Address: Licensee: Telephone#: 3064TH AVENUE ADVENTUROUS 12051221-5273 JASPER, AL 35501 BEGINNINGS, INC. Ages: Director (if applicable): Capacity: 3 Weeks through 6 Years THERESA BANKS 60 -Day SECTION B -DEFICIENCY INFORMATION Column I Column 2 Minimum Standard Date Corrected by Deficiency Licensee • U r4 rA\ . I I INSTRUCTIONS TO LICENSEE: Column 2,Date Corrected by License , 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 — Q—aoao , 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 1'censee to operate in compliance with Minimum Standards. . Signature of Facility Representative 14A ( Date aO Signature of DHR Licensing Representative 1,� T Date 1r ��— COPIES TO: Page \ of \