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—
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