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Deficiency Form (7) I I 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: PAM HOOKS DAY CARE Day ® Group ❑ Night ❑ Center ❑ /a�� / I 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 6 -Day SECTION B-DEFICIENCY INFORMATION Column 1 Column 2 Minimum Standard Date Corrected by Deficiency Licensee No , e C i r, ©n AoA INSTRUCTIONS TO LICENSEE: Column 2,Date Corrected bV 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 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 t see to see to op�te i complia a with Minimum complia a with Minimum Standards. Signature of Facility Representative �Dat �j -J7 Signature of DHR Licensing Representative Dat a1 COPIES TO: Page 1 of