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HomeMy WebLinkAboutDeficiency Form (8) I DHR-DFC-1926 ALABAMA DEPARTMENT OF HUMAN RESOURCES CHILD CARE MINIMUM STANDARDS DEFICIENCY REPORT SECTION A-IDENTIFYING INFORMATION Facili y Name: s Oh Type of F ility: Home ❑ Date of Visit: DayNight Group ❑, � e v / Ni t Center .�r`.�'` G��(— `4� D®� S.A.P. ❑ month/ day / .year Fac' ity�A^dd(rs 1,,� o� Licensee: �r Telephone#: Ages: Director(if applicable): Capacity: Wks, 920 [day / night ��� Q J Q Kl day / night SECTION B -DEFICIENCY INFORMATION Column 1 Minimum Standard Column 2 Deficiency Date Corrected by Licensee ) � e ' � � t + INSTRU TIONS TO LICENSEE: Column 2, Date Corrected by Licensee, is to be co pleted by the facility representative after'each'. deficienc}�is corrected The facility representative must put the date o ection ay rts/her initials in Column 2. This form must be returned o the Department of Human Resources on or be ore , 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 licensee to operate in compliance with Minimum Standards. Signature of Facility Representative Date ,,< -4-21.1.. Signature of DHR Licensing Repres41 Date__ COPIES O: 1 ( Page of I �r