in Received: PAGE 04/98 ““gi/@5/20e7 11:41 +994727-5519 DOF LEGAL_SERVICES STATE OF FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES IN THE MATTER OF Certified Mall 7005 1820 0002 0944 3100 A Civil Penalty Against Retum Receipt Requested Os hr, Se wt, i w% Honey Bear's Daycare, Inc. 0 T- 6) >) > BE, i) ad ; 193 Fouraker Road KES, cA “ Jacksonville, Florida 32210 BAe % . “Be “7 on ** ADMINISTRATIVE COMPLAINT ci % ¢ Jan 5 2007 11:33am YOU ARE HEREBY NOTIFIED that the Department has imposed a Civil Penalty in the amount. of One Hundred Dollars ($100,00). As grounds for the Imposition of this penalty, the Department states the following: 1. The Department of Children and Families; State of Florida, has Jurisdiction over , Respondent by virtue of the provisions of Chapters 402,301 — 402,319, Florida Statutes. 2. The Respondent, Shirley Jackson, is licensed to Operate Honey Bear's Daycare, Inc, located at 1903 Fouraker Road, Jacksonville, Florida, 32210 as a Child Care Facility in compliance with Chapter 402, Florida Statutes (F.S,), and Florida Administrative Code (F.A.C), Rule 65C-22, 3. During a complaint investigation on October 25, 2006, it was determined that the Resvondent committed the following violation: 4, FAC Chapter 65C-001(5)(a), in that; On October 23,. 2008, .a.child. K.S,was-sbserved- with a severe scratch over his right eye. The staff members 8.J., hired March 20, 2006 and B.F., hired May 3, 2006, who cared for the child that day had no explanation as to when or how the child’s eye was scratched. However, it was determined that the child's eye was injured while at the child care facility, and that there was not appropriate direct supervision by the staff, Although this has not been cited before this is a class one violation, The above referenced violation constitutes grounds to levy this Civil Penalty pursuant to se,402,310( 1)(a) and 402.31 0(4), Florida Statutes at the above referenced conduct of Respondent constitutes a Violation of the minimum Standards, rules and regulations for the operation of a Child Care Facility. . Recelved: Jan § 2007 11:33am ‘ a1 /85/ 2007 11:41 +984727-5519 . DCF LEGAL_SERVICES PAGE 85/88 t Administrative Complaint — Honey Bear's Daycare, Inc. Page 2 5. Payment of this fine can be made directly to the Department of Children and Family Services. The mailing address is: P.O, Box 2417, Jacksonville, FL. 32231, Attention: Child Care Licensure. 6. Pleasa be advised that you do have the right to contest this Civil Penalty through an administrative hearing pursuant to Section 120.57, Florida Statutes, but that you have na more than twenty one (21) days from the date the Administrative Complaint is received to initfate this formal review. To initiate this formal review process, a petition for formal hearing must be received by the fallowing individuals within the twenty-one-day time frame: Roger L.D, Williams Gregory D. Venz, Agency Clerk Assistant General Counsel Department of Children & Families Department of Children & Families Office of the General Counsel P.O, Box 2417 1317 Winewood Blvd., Bldg. 2, Ste 204 Jacksonville, FL. 32231-0083 Tallahassee, FL. 323014 No later than fifteen (15) days after recelpt of your written request for a formal hearing, the request for a hearing shall be granted or denied. Absent the consent of all parties, the hearing ! will not commence on fewer than fourteen (14) days notice. : Finally, in accordance with s, 120.57(b)(4), Florida Statutes (2004), all parties to this cause have the opportunity to respond, to present evidence and argument of all issues of involved, to’ conduct cross-examination and submit evidence, to submit proposed findings of facts and order, to file exceptions ta any order of a hearing officer's recommended order, and to be represented by counsel (at your expense),__In addition, you have.the right to, have. subpoenas_.... . ’ and subpoefas duces tecum issued. Your request for an administrative hearing must state what issues and material facts you dispute, or it will be dismissed. FAILURE TO DISPUTE MATERIAL ISSUES OF FACT IN YOUR REQUEST FOR A HEARING MAY BE TREATED BY THE DEPARTMENT OF CHILDREN AND FAMILY SERVICES AS AN ELECTION BY YOU FOR THE INFORMAL PROCEEDINGS UNDER s. 120.57(2), FLORIDA STATUTES (2004). NOTICE OF RIGHTS This decision constitutes final agency action unless a person who Is substantially affected by it submits a written request for hearing that is received within twenty-one days from the date on which he or she first receives this notice. The request for hearing must also meet the requirements of Section 120,56, F.S., and either Rule 28-106.201 or Rule 28-106,301, F.A, Cc. or Ise jt will be dismissed as required by Section 120.569(2)(c), F.S, That law and those rules require the written request for hearing to include the following information: Dok, Received: __ Jan 6 2007 11:34am 01/85/2887 11:41 +984727-5519 DCF LEGAL_SERVICES PAGE 86/09 ‘ Administrative Complaint — Honey Bear's Daycare, Inc. Page 3 1. The name and address of each agency affected and each agency's file or identification number if known; 2, The name, address, and telephone number of the person who ts asking for the hearing (the petitioner); 3. The name, address, and telephone number of the petitioner's representative, if any; 4. An explanation of how the petitioner's substantial interests are or will be affected by the agency decision; 5, - A statement of when and how the petitioner received notice of the agency decision; 6. A statement that the petitioner does not dispute the facts upon which the agency relied but that It wants to exercise the right to be heard anyway OR a statement that the petitioner does dispute the facts upon which the agency relied and a list of the facis in dispute; 7. Aconcise statement of the facts as the petitioner percelves them to be, Including the specific facts set out by the agency that the petitioner wants the agency to reverse or change; 8. A statement of the specific rules or statutes that the petitioner believes requires the , agency to reverse or modify its decision; and 9. A statement specifying what action the petitioner wants the agency to take in the matter, Failure to request a hearing in writing and within the time frames required in this notice or fallure to provide the information required by the law and rules governing requests for Chapter «0 hearings constitutes a complete waiver of any right that a substantially affected person may have to challenge this decision. ‘ The request must be received by the following persons at the following addresses on or before twenty-one (21) days of the date on which this notice was first received by the person requesting the hearing: Roger L.D, Williams Gregory D. Venz, Agency Clerk Assistant General Counsel Department of Children & Families Department of Children & Families Office of the General Counsel P.O, Box 2417 ’ 1323 Winewood Blvd., Bldg. 1, Suite 407 Jacksonville, FL, 32231-0083 Tallahassee, FL, 32301 STATE OF FLORIDA, DEPAR FAMILIES Pantela Buckham/ { Program Administrator 4 Recel ved: Jan 5 2007 11:34am @1/@5/2887 11:41 +984727-5519 DCF LEGAL_SERVICES PAGE 87/88 CERTIFICATION OF SERVICE | HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail 7005 1620 0002 0944 3100, Return Receipt Requested, in accordance witn ss, 120,60(3), Florida. Statutes (2005), this [4day of December, 2006. STATE QF FLORIDA, Program Administrator Jan § 2007 11:34am - Recelved: pase 98/88 . ai/a5/ 2007 11:41 +994727-5519 DCF LEGAL_SERVICES A : COMPLETE THIS SECTION ON DELIVERY B. Agcefved by tie hg iY. HA ¢ fl inn 4 D, 1d delivery actress differant trom item 17 Cl Yer JEYES, anter delivery addrese bataw: O\No ™ Print your name and address on the * go that we can retum the oard to y | m Attach this card to the back af tha maliplecd, 1" of on the front ifspace penntts. 1. Article Addressed to: ™ Complete Items 1, 2, and 3, Also compigte Item 4 If Restricted Dativery is core ‘ | | I. | . Honey Bear's Daycare, Inc. | ' 1903 Fouraker Road Jacksonville, Florida 32210 | . ‘ , | | 1 “| Sarvice Type Ci Certtied Mal (1 Express Mall . 0 Registered C1 Return Racelpt for Merchandise Dinsured Mal C1. c.0.D, 4, Restricted Dallvary? (Extra Foo) [Oe Teo tell 7OOS 2820 OO0e O44 aLOo | penne BED OOO DARN SOO | PS Form 9811, February 2004 Domestic Return Recelpt . WR5BRDANSa0 } | Cee eemuary 200 o° NS 3 3 ' Ye. 23 KEG P gt Bae S : GLa @ Pa a3) aD RECEIVED DEC 15 2005 OEPT, OF CHILOREN & FAMILIES CHILD CARE LICENSURE

Docket for Case No: 07-000328