res Ol- ALoll Ponte Vedra Beach, FL. 32082 ADMINISTRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED that the Department has imposed a Civil Penalty in the amount of Fifty Dollars ($50.00). As grounds for the imposition of this penalty, the Department states the following: ) t. The Department of Children & Families, State of Florida, has jurisdiction over Respondent by virtues of the provisions of Chapter 402.301 - 402.319, Florida Statutes. 2. The Respondent, YMCA of Florida’s First Coast, is licensed to operate YMCA , Pryme Time @ Ocean Palms Elementary as a child care facility in compliance with Florida Statutes, Chapter 402, and F lorida Administrative Code (FAC) Chapter 65C-22. 3. During an inspection on April 18, 2001, it was determined that the Respondent committed a violation, FAC Chapter 65C-22. 006(6)(e), in that: Documentation that a staff member had met the first-aid and infant and child cardiopulmonary resuscitation training requirements was unavailable for review, This facility has a history of non-compliance by ~ failure to have the required documentation for review in on-site personnel files. This violation was previously cited on May 12, 2000, when there was no staff member present who had documentation of a valid certifi icate of course completion for first-aid training. A warning letter was issued on 1 May 16, 2000, with regards to this violation. This violation was again cited on November 29, 2000, when there was no staff member present who had documentation of having met the first-aid and infant and child _ . cardiopulmonary resuscitation-training requirements. A second | warning letter was issued on December 1, 2000. P.0o2 Jun-08-01 12:18P . . : aN < fe 7 @ LO STATE OF FLORIDA Ay, Py DEPARTMENT OF CHILDREN & FAMILIES Motley > OY no . 4 S73 oe 2 IN THE MATTER OF - type); ‘ys A Civil Penalty Against Certified Mail 7000-2870-0000-2024-2774 °S Eliazar Gonzalez Return Receipt Requested YMCA Pryme Time @ Ocean Palms Elementary 170 Landrum Lane a Mi a ee tes P.O3 Jun-O8-0O1 12:18P , + Administrative Complaint - YMCA Pryme Time @ Ocean Palms Elementary May, 2001 Page 2 4, The above referenced violation constitutes grounds to levy this Civil Penalty pursuant to Chapter 402, Florida Statutes, in that the above referenced conduct of Respondent constitutes 2 violation of the minimum standards, rules and regulations for the operation of a child care facility, 5. Payment of this fine can be made directly to the Department of Children and Families. The mailing address is: PO Box 2417, Jacksonville, FL 32231, Attention: Child Day Care Licensure. 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 (21) days from the date on which he or she first receives this notice. The request for hearing must also meet the requirements of Section 120.562, Florida Statutes and either Rule 28-106.201 or Rule 28-106.301, Florida Administrative Code, or else it 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: ‘ 1. The name and address of each agency affected and each agency's file or identification number ifknown; 2. The name, address and telephone number of the person who is asking for the hearing {the petitioner); 3. The name, ess 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; 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 facts in dispute; Jun-08-O1 12:18P ’ 3% Administrative Complaint - YMCA Pryme Time @ Ocean Palms Elementary May, 2001 Page 3 7, A concise statement of the facts as the petitioner perceives 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 failure to provide the information required by the law and rules governing requests for Chapter 120 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 Williams Virginia Daire, Agency Clerk Assistant General Counsel Department of Children & Families Department of Children & Families Office of the General Counsel P.O. Box 2417 ‘ 1323 Winewood Bivd., Bldg. 1, Ste 407 Jacksonville, FL. 32231-0083 Tallahassee, FL. 32301 STATE OF FLORIDA, DEPARTMENT OF CHIDLREN AND FAMILIES Naney Corley . \ Program Administrator Jun-08-01 12:19P ‘ « cy Administrative Complaint - YMCA PT @ Ocean Palms Elementary May, 2001 . Page 4 CERTIFICATION OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by _US. Certified Mail, 7000-2870-0000-2024-2774, Return Receipt Requested, in accordance with ss. 120.60(3), Florida Statutes, this > gt day of May, 2001. STATE OF FLORIDA, DEPARTMENT OF CHILDREN & FAMILIES Nancy Cottey \ Program Administrator -O5

Docket for Case No: 01-002611