State of Florida Governor Department of Children and Families Esther Jacobo Interim Secretary RE Dy a NAN MYFLFAMILIES.COM William S. D’Aiuto Regionat Managing Director STATE OF FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES Certified Mail Return Receipt No. 7013 0600 0001 8073 6529 To: Holder Family Day Care Home Attention: His Holder 433 Spike Court Kissimmee, Florida 34759 ADMINISTRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED the Department is proposing to impose administrative fines totaling $200.00. 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 Holder Family Day Care Home for violations of child care licensing standards in sections 402.301 — 402.319, Fiorida Statutes, and chapter 65C-20, Florida Administrative Code. 2. His Holder, is licensed under chapter 402, Florida Statutes, and chapter 65C-20, Florida Administrative Code, to operate a family day care home known as Holder Family Day Care Home located at 433 Spike Court, Kissimmee, Florida 34759. The family day care home license is currently an Annual License. 3. During a routine inspection conducted on March 21, 2014, you failed to maintain supervision as required. A child was observed leaving the provider's home with another child who was not in care. 4. The foregoing facts violate Rule 65C-20.009(5)(a), Florida Administrative Code (F.A.C.). 5. The violation described in the paragraph above is a Class | violation of a child care licensing standard. This is the facility’s first occurrence of a Class | violation within a two-year period. The fine for the March 21, 2014 violation is $200.00. Central Region @ 1055 Highway 17 North® Florida 33830 Mission: Protect the Vulnerable, Promote Strong and Economically Self-Sufficient Families, and Advance Personal and Family Recovery and Resiliency If you do not wish to contest the findings of this administrative complaint, payment of the fine amount may be made directly to the Florida Department of Children and Families, Child Care Regulation Office, 200 N Kentucky Ave, Suite 322, Lakeland, FL 33801. You may also enclose your original Certificate of License. If you wish to contest the findings of this administrative complaint or the sanctions imposed, you may do so as provided in the notification of rights below. 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 IN WRITING AND MUST BE RECEIVED BY THE DEPARTMENT WITHIN 21 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 TOA HEARING. You may submit your request for an administrative hearing to the Department at the following addresses: Cheryl D. Westmoreland, Esquire Assistant Regional Counsel, Circuit 10 1055 Highway 17, North Bartow, Florida 33830 Please note 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 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; (c) An explanation of how the petitioners substantial interests will be affected by the agency determination; (d) A statement of when and how the petitioner received notice of the agency decision; (e) A statement of all disputed issues of material facts. If there are none, the petition must so indicate; (f) 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; (g)A statement of the specific rules or statutes the petitioner contends require reversal or modification of the agency’s proposed action, including an explanation of how the alleged facts relate to the specific rules or statutes; and (h) 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 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 O RVI | HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by certified mail return ipt to llis Holder c/o 433 Spike Court, Kissimmee, Florida 34759 this 72" “day of Lael. , 2014, an Demetria Nail Chitd Care Regulations Counselor

Docket for Case No: 14-002087