STATE OF FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES IN THE MATTER OF Certified Mail 7011 0470 0002 3594 3233 A Civil Penalty Against Return Receipt Requested Gail Shivers d/b/a Shivers Family Day Care Home 6863 Cinderella Road Jacksonville, Florida 32210 ADMINISTRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED that the Department has imposed a Civil Penalty in the amount of One Hundred Dollars ($100.00) against Gail Shivers, d/b/a Shivers Family Day Care Home. As grounds for the imposition of this penalty, the Department states the following: 1. The 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, Gail Shivers, is licensed to operate Shivers Family Day Care Home - License #F04DU1241, located at 6863 Cinderella Road, Jacksonville, Florida 32210, as a Family Day Care Home in compliance with Chapter 402, Florida Statutes (F.S.), and Florida Administrative Code (F.A.C), Rule 65C-20. Violation 3. During a complaint investigation conducted on June 13, 2011, a DCF Licensing Counselor, Nancy Starling, determined that: An unscreened individual had been left alone to supervise children in care. When Counselor arrived, she observed that the Provider's daughter, R.S., who is not an approved substitute, and who had completed neither childcare training nor background screening, caring for six (6) napping children by herself. Her mother, the Provider, was napping in another room. 4. FAC Rule 65-20,008(3)&(4), states, that child care personnel in the Family Day Care Homes, shall be subject to the applicable screening provisions contained in ss. 402.305(2) and 402.3055. Screening means the act of assessing the background of child care personnel and volunteers and includes, but is not limited to, Employment History Checks, Local Criminal Records Checks through Local Law Enforcement Filed October 4, 2011 2:18 PM Division of Administrative Hearings Agencies, fingerprinting for all purposes and checks in this subsection, Statewide Criminal Checks through the Department of Law Enforcement, and Federal Criminal Checks through the Federal Bureau of Investigation. Pursuant to the Florida Administrative Code Rule 65C-20.008(3)&(4), this is a Class 1 violation. Pursuant to the Family Day Care Home Standards Classification Summary, CF-FSP Form 5318, Item #3-Background Screening Requirements, the fine for this first Class 1 violation is not less than $100.00 nor more than $500.00 per day, however, this fine is being assessed in the amount of $100.00, as this was the Provider's first major violation. 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 Department 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 Blvd., 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) A statement 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 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) A statement 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, DEPARTME F CHILDREN AND FAMILIES Ge. Pamela Buckham Safety Program Manager CERTIFICATION OF SERVICE THEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, 7011 0470 0002 3594 3233 Return Receipt Requested, in accordance with ss. 120.60(3), Florida Statutes (2005), this Letty of September, 2011. STATE OF FLORIDA, DEPAR NT OF CHILDREN & FAMILIES Pamela Buckham afety Program Manager SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION.ON DELIVERY Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. . Hf Print your name and address on the reverse so that we can return the card to you. i Attach this card to the back of the mailpiece, or on the front if space permits, 1. Article Addressed to: A Signature 7 4 . FY o Agent 1 Xda byl & Les EI Addressee , B. Received by (Printed Name) Gy efi ' . hail Shivers d/b/a Shivers Family Day Care Home 6863 Cinderella Road Jacksonville, Florida 32210 3, Service Type Cl Certified Mal! [J Express Mail C Reglstered (J Return Recelpt for Merchandise Cl tnsured Mall [1 6,0.D. : 4, Restricted Delivery? (Extra Fee) D0 Yes { 2. Article Number 7011 0470 D002 3594 3233 ey LN RATED IC FEET naman t (Transfer from service label) PS Form 381 1, February 2004 Domestic Return Recelpt 102595-02-M-1840 ! ’

Docket for Case No: 11-005111