Loading...
Deficiency Form (5) l ' n � / ALABAMA:� �- -DEPARTMENT OF HUMAN RESOURCES DHR-DFC-1926 CHILD CARE MINIMUM STANDARDS DEFICIENCY REPORT / SECTION A-IDENTIFYING INFORMATION Facility Name: Type of Facility: Home Date of Visit: PAM HOOKS DAY CARE Day � Group ❑ � / ( / lq Night Center ❑ Day/Night ❑ S.A.P ❑ month / day / year Facility Address: Licensee: Telephone#: 9325 TWIN BEECH RD PAMELA HOOKS (251)928-2286 FAIRHOPE,AL 36532 Ages: Director (if applicable): Capacity: 6 Weeks through 5 Years N 6 -Day SECTION B-DEFICIENCY INFORMATION Column I Column 2 Minimum Standard Date Corrected by Deficiency Licensee R re- n G' over 5 vectors 01d . 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 corre ton a d his/her initials in Column 2. This form must be returned to the Department of Human Resources on or before 1 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 see to operate in compliance with Minimum Standards. Signature of Facility Representative Date Signature of DHR Licensing Representative _W. ' Qse� Date 40 COPIES TO: Page of