reum, 04/26/2013 10:01 #620 P.002/004 STATE OF FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES AF Augustina Academy Inc 1307 Pine Hills Road Orlando, Florida 32808 Certified Mail Return Receipt No. 110 0240 0000 9890 W043 ADMINISTRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED that the Department has imposed a Civil Penalty in the amount of $300. The Department’s authority and grounds to impose this sanction are explained below. 1. The Department of Children and Families is authorized by section 402.310, Florida Statutes, to sanction Augustina Academy Inc for violations of child care licensing standards in sections 402.301- 402.319, Florida Statutes, and chapter 65C-22, Florida Administrative Code. 2. Augustina Academy inc is licensed under chapter 402, Florida Statutes, and chapter 65C- 22, Florida Administrative Code, to operate a child care facility known as Augustina Academy Inc located at 1307 Pine Hills Road, Orlando, Fl 32808. The facility license is currently a Regular License. 3. Respondent committed a Class 2 licensing violation of 65C-22.001(6)(£),(g) Florida Administrative Code, with respect to Transportation. On January 15, 2013, the facility did not have evidence that a log was maintained for all children transported. The inspection for January 15, 2013 is attached as Exhibit “A”. On January 31, 2013, the facility did not have evidence that a log was maintained for all children transported. The inspection for January 31, 2013 is attached as Exhibit “B”. 4. The above referenced violations constitute grounds to levy this Civil Penalty pursuant to s. 402,3125(9)(2} F, S., in that the above referenced conduct of Respondent constitutes a violation of the minimum standards, rules and regulations for the operation ot a Child Care Facility. 5. The violation described above is a Class I violation of child care licensing standards. It is the facility’s second occurrence of Class I] of No Log standard within a two year period. There are no prior violations of this standard, Technical assistance was given to provider in regards to Transportation. The fine imposed for this violation is $50, 5. Respondent committed a Class 1 licensing violation of 65C-22.001(9),(11) Florida Aduinistrative Code, with respect to Access/Child Abuse or Neglect/Misrepresentation. On January 31, 2013, Child Care personnel misrepresented information, impersonated, or provided fraudulent information related to the child care facility to a parent/guardian, From: 04/26/2013 10:01 #620 P.003/004 licensing authority, or law enforcement. The inspection for January 31, 2013 is attached as Exhibit “B”. 7. The above referenced violations constitute grounds to levy this Civil Penalty pursuant to s. 402.319 F. S,, in that the above referenced conduct of Respondent constitutes a violation of the minimum standards, rules and regulations for the operation of a Child Care Facility. 8. The violation described above is a Class I violation of child care licensing standards. It is the facility’s first occurrence of Class I of Fraudulent Information Provided standard within a two year period. There are no prior violations of this standard. Technical assistance was given to provider in regards to Transportation. The fine imposed for this violation is $250. PAYMENT OF FINE, IF NOT CONTESTED If you do not wish to contest the findings of the administrative complaint, payment of the fine amount can be made by money arder or cashier’s check directly to the Department of Children and Families, Child Care Regulations Office. The mailing address is Department of Children and Families Attention: Child Care Licensing Office 1507 N John Young Parkway Kissimmee, Florida 34741 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 DAYS OF YOUR RECEIPT OF THIS NOTICE. FAILURE TO REQUEST AN ADMINISTRATIVE HEARING WITHIN THE 2t DAYS PROVIDED SHALL CONSTITUTE A WAIVER OF THE RIGHT TO A HEARING. You may submit your request for an administrative bearing to the Department at the following address: T. Shane DeBoard, Esquire Department of Children and Families C/O District Legal Office, $-1129 400 West Robinson Street Orlando, Florida 32801-9425 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; From: 04/26/2013 10:01 #620 P.004/004 (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. Mediation as described in section 120.573, Florida Statutes, may be available if agreed to by all parties, and on such terms as agreed to by all parties. The right to an administrative proceeding is not affected when mediation does not result in a settlement, CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by certified mail return receipt to Lanita Peterson Director of, Augustina Academy Inc,1307 Pine Hills Road, Orlando, Fl 32808, by U.S. Certified Mail, Return Receipt Requested, in accordance with s, 120.60(3), Florida Statutes, this {87 day of Maa ch__, 2013. Avida Rosa Child Care Licensing Supervisor 1507 North John Young Parkway Kissimmee, Florida 34741 (407) 846-5148

Docket for Case No: 13-001833