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HomeMy WebLinkAboutDeficiency Form (6) Mar 04 20 02:07p Adventurous Beginnings 2052215273 p.1 ALABAMA DEPARTMENT QF HUMAN RESOURCES DHR-DFC-1926 CHILD CARE MINIMUM STANDARDS DEFICIENCY REPORT SECTION A-IDENTIFYING INFORMATION Facility Name: Type of Facility: Home ❑ Date of Visit: ADVENTUROUS BEGINNINGS,INC. Day ® Group ❑ Night ❑ Center 00 Day/Night ❑ S.AJ' ❑ month I— day / year Facility Address: Licensee: Telephone#: 306-4TH AVENUE ADVENTUROUS (2051221-5273 JASPER,AL 35501 BEGINNINGS,INC. Ages: Director(ifapplicable): Capacity: 3 Weeks through 6 Years THERESA BANKS 60-Day SECTION B-DEFICIENCY LNFORMATION Column I Column 2 Minimum Standard Date Corrected by DeficiencyLicensee -Ta �s-oc —� d i I 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 hbAcr initials in Column 2. Thb form must be returned to the Department of Human Resources on or before as verification that deficiencies have been correcteA 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 211DW anyone to operate is violation of wnimum 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 operate inin compliance with Minimum Standards. Signature of Facility Representative ►ti .1 Date � Signature of BHR Licensing Representative ,�„_. Date�r ��—c�p�� COPIESTO: �� - �j� C��1 'e'q— �L age of