1 Sep-12-01 12:37P STATE OF FLORIDA . DEPARTMENT OF CHILDREN & FAMILIES , Qn, i Sy Agy LW SY Leo IN THE MATTER OF Meee yO A Civil Penalty Against Certified Mail 7000-16 S523 148 Renee Pulumbarit Return Receipt Requested € 566 Charles Pinckney Street Orange Park, FL. 32073 ADMINISTRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED that the Department has imposed a Civil Penalty in the amount of One Hundred and Fifty Dollars ($150.00). As grounds for the imposition of this penalty, the Department states the following: 1. 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, Renee Pulumbarit, is licensed to operate a family day care home . ‘in compliance with Florida Administrative Code (FAC) Chapter 65C-20 and Florida Statutes, Chapter 402. 3. During an investigation on August 9, 2001, it was determined that the Respondent committed the following violations: a. FAC Chapter 65C-20.009(3)(a), in that: A child was observed alone in a dark room, awake in a crib. {At all times, which includes when the children are sleeping, the operator shall remain responsible for the supervision of the children in care and capable of responding to the emergencies and needs of the children. During the daytime hours of operation, children shall have adult supervision which means watching and directing children’s activities, both indoors and outdoors, and responding to each child’s needs. b. FAC Chapter 65C-20.012(3), in that: The operator did not allow access to the home. The family day care operator must allow access to the entire premises of the family day care home to inspect for compliance with family day care minimum standards. A. The above referenced violations constitute grounds to levy this Civil Penalty pursuant to Chapter 402, Florida Statutes, in that the above referenced conduct of Respondent constitutes a violation of the minimum standards, rules and regulations for the operation ofa Family Day Care Home, cotib, Meats ek geen s- Sep-12-01 12:37P P.o2 ee on * Administrative Complaint — Renee Pulumbarit A August, 2001 %, Page 2 &: a eS : OY, @ Q a 5. Payment of this fine can be made directly to the Departmen, gPBsebien od Families. The mailing address is: PO Box 2417, J acksonville, FL 32231, Atego gniid’g ay Day Care Licensure. os he 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 if known; 2. The name, address and telephone number of the person who is asking for the hearing (the petitioner), 3. Thename, address 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, 5. A statement of when and how the petitioner received notice of the agency decision, 6. A statement that the petitioner does not dispute the facts upon which the agency relied but 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, 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 eo a. ae Sep-12-01 12:37P g : aM. Administrative Compliant — Renee Pulumbarit August, 2001 Page 3 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 Nancy Colley . . Program Administrator = Sep-12-01 12:38P 7 + * € N «oy Administrative Complaint — Renee Pulumbarit August, 2001 Page 4 CERTIFICATION OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, 7000-1670-001 1-1323-3148, Return Receipt Requested, in accordance with ss. 120.60(3), Florida Statutes, this \\"S-_ day of August, 2001. STATE OF FLORIDA, DEPARTMENT OF CHILDREN & FAMILIES Send Nancy Corl Program Administrator Seca

Docket for Case No: 01-003856