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HomeMy WebLinkAboutDeficiency Form (9) 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 DISON PREMIER PRESCHOOL Day ❑ Group ❑ / Night ❑ Center ER] �5 9J Day/Night [k] S.A.P ❑ month / day / year Facility Address: Licensee: Telephone#: 1827 SLAUGHTER ROAD ALLEN EDUCATIONAL (256)864-8450 MADISON, AL 15751 OPPORTUNITIES, INC. Ages: Director(if applicable): Capacity: 6 Weeks through 12 Years LATONYA JAMES 146 -Day 6 Weeks through 12 Years 20 -Day/Night I SECTION B -DEFICIENCY INFORMATION Column I Column 2 Minimum Standard Date Corrected by Deficiency Licensee o GQe' �?e.,�`�s rL + INSTRUCTIONS TO LICENSEE: Column 2 Date Corrected b ens 's to be completed by the facility representative after each deficiency is corrected. The facility representative mustp it t date of Corr 'on and his/he ' ttials in Column 2. This form must be returned to the Department of Human Resources on o ore , as verification that defici!ncies have been corrected. NOTICE: 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 violati'on 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 to perate in pliane 'th Minimum Standards. Signatli re of Facility Representative Dat Signature of DHR Licensing Repres Dat COPI S TO: Page 9 of-7L