STATE OF FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES - Amelia Island Parent Cooperative Preschool, Inc. P.O. Box 1451 Fernandina Beach, Florida 32034 ; inti. {N THE MATTER OF Certified Mail 7609 3410 0001 6528 5643 eG ei US Noy A Civil Penalty Against Return Receipt Requested de OpAF Gin . pa Gt Ue! WL “os ADMINISTRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED that the Department has imposed a Civil Penalty in the amount of Twenty-Five Dollars ($ 25 .00), against Amelia Island Parent Cooperative Preschool, Inc.. As grounds for the imposition of this penalty, the Department states the following: ] 1. The State of Florida, Department of Children and Families (DCF) has jurisdiction over this matter by virtue of the provisions of Sections 402.301 — 402.319, Florida Statutes. : 2. The Respondent, Amelia Island Parent Cooperative Preschool, Inc., is licensed to operate Amelia Island Parent Cooperative Preschool-License # CO4NA0060, located at 5040 First Coast Highway, Femandina Beach, Florida 32034,as a Child Care Facility in compliance with Chapter 402, Florida Statutes (F.S.), and Florida Administrative Code {(F.A.C), Rule 65C- 22. i Violation 3. During an inspection on March 25, 2010, a DCF Licensing Counselor determined that: An annual Childcare Attestation of Good Moral Character was missing for staff member J.G., hired October 21, 2008. 4, FAC Rute 65C-22.006 (4) (d) (3), states, records shall be maintained and kept current on all childcare personnel, as defined by Section 402.302 (3), F.S., and household members if the facility is located in a private residence. These shall include Level 2 screening information documented on CF-FSP Form 5131, February 2004, Background Screening and Personnel File Requirements, which is incorporated by reference. CF 1649A, January 2007, A Childcare Attestation of Good Moral Character, which is incorporated by reference, must be completed annually for all childcare personnel. Pursuant to the Florida Administrative Code Rule 65C-22.006 (4) (d) (3), this is a Class 3 violation. This same Class 3 violation was previously cited on November 12, 2008 and April 15, 2009. Pursuant to the Child i t i i i Care Facility Standards Classification Summary, CF-FSP Form 5316, Item #60-Background screening documents, the fine for this third Class 3 violation is $25.00. 5. The above referenced violation constitutes grounds to levy this Civil Penalty pursuant to ss.402.310(1)(a) and 402.310(4), Florida Statutes as the above referenced conduct of Respondent constitutes a violation of the minimum standards, rules and regulations for the operation of a Child Care Facility. 6. Payment of money order or cashier’s check for this fine can be made directly to the Depariment of Children and Family Services. The mailing address is: 5920 Arlington Expressway, P.O. Box 2417, Jacksonville, FL. 32231, Attention: Child Care Licensure. 7. Failure to pay the fine imposed in this Administrative Complaint will result in an automatic non-renewal of the license referenced above. NOTICE OF RIGHTS NOTIFICATION OF RIGHTS UNDER CHAPTER 120, FLORIDA STATUTES IF YOU BELIEVE THE DEPARTMENT'S DECISION IS IN ERROR, YOU MAY REQUEST AN ADMINISTRATIVE HEARING TO CONTEST THE DECISION. YOUR REQUEST FOR AN ADMINISTRATIVE HEARING MUST BE RECEIVED BY THE DEPARTMENT WITHIN 21 CALENDAR DAYS OF YOUR RECEIPT OF THIS NOTICE. FAILURE TO REQUEST AN ADMINISTRATIVE HEARING WITHIN THE 21 DAYS PROVIDED SHALL CONSTITUTE A WAIVER OF THE RIGHT TO A HEARING. You may submit your request for an administrative hearing to the Department at the following addresses: David Tucker Gregory D. Venz, Agency Clerk Chief Legal Counsel Department of Children & Families Department of Children & Families Office of the General Counsel P.O. Box 2417 1323 Winewood Bivd., Bldg. 1, Suite 407 Jacksonville, FL. 32231-0083 Tallahassee, FL. 32301 Please note that a request for an administrative hearing must comply with section 120.569(2) (c), Florida Statutes, and Rules 28-106.201(2), Florida Administrative Code. Those provisions, when read together, require a petition for administrative hearing to include: (a) The name and address of each agency affected and each agency's file or identification number, if known; (b) The name, address, and telephone number of the petitioner; the name, address, and telephone number of the petitioner's representative, if any, which shall be the address for service purposes during the course of the proceeding; and an explanation of how the petitioner’s substantial interests will be affected by the agency determination; ; (c) Astatement of when and how the petitioner received notice of the agency decision; : ‘ (d) A statement of all disputed issues of material facts. If there are i none, the petition must so indicate; (e) A concise statement of the ultimate facts alleged, including the specific facts the petitioner contends warrant reversal or modification of the agency's proposed action; (f) Astatement of the specific rules or statutes the petitioner contends require reversal or modification of the agency's proposed action; and (g) A statement of the relief sought by the petitioner, stating precisely the action petitioner wishes the agency to take with respect to the agency’s proposed action. . Section 120.569, Florida Statutes, and rule 28-106.201(4), Florida Administrative Code, require that a petition to be dismissed if it is not in substantial compliance with the requirements above. Pursuant to section 120.573, Florida Statutes, the Department advises that formal mediation is not available for this administrative complaint. However, the Department may consider proposals to resolve the complaint without a formal hearing. STATE OF FLORIDA, DEPARTMENT)OF CHILDREN AND FAMILIES Pamela Buckham Safety Program Manager CERTIFICATION OF SERVICE | HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, 7009 3410 0001 6528 554 fetun Receipt Requested, in accordance with ss. 120.60(3), Florida Statutes (2005), this _/7 “Hay of April, 2010. STATE OF FLORIDA, j y i i Safety Program Manager ' | | |

Docket for Case No: 10-003187