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HomeMy WebLinkAboutDeficiency Form (7) 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: M 6SON PREMIER PRESCHOOL Day ❑ Group ❑ Y� Night ❑ Center ® t / f Day/Night © S.A.P ❑ month / day / year Facility Address: Licensee: Telephone#: 1827 SLAUGHTER ROAD ALLEN EDUCATIONAL (256)864-8450 MADISON,AL 35758 OPPORTUNITIES, INC. Ages: Director (if applicable): Capacity: 6 Wleeks through 12 Years LATONYA JAMES 146 - Day 6 leeks through 12 Years 20 -Day/Night SEC ION B -DEFICIENCY INFORMATION Co.umn 1 Column 2 Minimum Standard Date Corrected by Deficiency Licensee I i a � INSTRUCTIONS TO LICENSEE: Column 2 Date Corrected b Licen to be completed by the f ility representative after each feficieney is corrected. The facility representative mustput the d to of correc r d his/h itials in Column 2. This form must be returned to the Department of Human Resources on or , as verification that deficiencies have been corrected. NOT CE: Any misleading or any false statements or reports made to the Department and/or failure to correct the listed defici ncies 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 a see o operate ' compb a with Minimum Standards.. Signature of Facility Representative Dat - 7'2Ozo Signat I re of DHR Licensing Represe —k,44— Date COPIES TO: 1 T O Page /of