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Deficiency Form (20) 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: LIVINGSTON HEAD START CENTER Day © Group ❑ Night ❑ Center ® 9 / Z Z/ 0 Day/Night El S.A.P ❑ month / day / year Facility Address: Licensee: Telephone#: 215 NELSON HUGHES SUMTERI COUNTY (205)652-7554 LIVINGSTON, AL 35470 OPPORTUNITY, INC. Ages: Director (if applicable): Capacity: 0 Weeks through 5 Years TRAKAYLA BROWN 45 - Day SECTION B-DEFICIENCY INFORMATION Column 1 Column 2 Minimum Standard Date Corrected by Deficiency Licensee re, , 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 his/her initials in Column Z This form must be returned to the Department of Human Resources on or before , 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 th isee to o ate in co npliance with Minimum Standards. Signature of Facility Representative Dat Signature of DHR Licensing Representative Date 9-2.7.- COPIES TO: �ejnArvr mc*%A>�" Fe�ibA -in r A 1 S �{ Page ( of