62/85/2884 13:65 723-2122 CHILD CARE LICENSURE PAGE 62 STATE OF FLORIDA 04 Fey DEPARTMENT OF CHILDREN AND FAMILIES IS Alin, 20 Dijon, IN THE MATTER OF Certified Mail 7001-2510-00DB¢pgno.g6 19 A Civil Penalty Against Return Rechipt) fost ve Exceptional Day Care and The Arts 5111 North Pearl Street LOU RS Jacksonville, Florida 32208 LY TKS ADMINISTRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED that the Department has imposed a Civil Penalty in the amount of One Hundred Fifty Dollars ($150.00). As grounds for the imposition of this penalty, the Department states the following: 1. The Department of Children and Families, State of Florida, has jurisdiction over tne Respondent by virtue of the provisions of Chapters 402.301 — 402.319, Florida Statutes, 2. The Respondent, Emestine Jefferson, is licensed to operate Exceptional Day Care and The Arts, as a child care facility in compliance with Chapter 402, Florida Statutes (F.S.), and Florida Administrative Code (FAC), Chapter 65C-22. 3. During an inspection on December 19, 2003, it was determined that the Respondent committed the following violations: a. FAC Chapter 65C-22.001(6)(a), in that: A driver substitute, J.A., did not have a physical examination and did not have a copy of his driver's license on file at the facility. A similar violation was cited January 16, 2002, resulting in an administrative complaint (fine), in the amount of $100.00, being issued on January 30, 2002. b. FAC Chapter 65C-22.006(5)(e and d), in that: Thera was a staff member, C.L., that works more than 40 hours a month and is sometimes in charge of a group of children. That staff member cannot be considered a volunteer and needs Level 2 background screening, In addition, the part-time van driver, J.A., needs Level 2 background screening. Similar violations were cited on October 15, 2009, and on May 7, 2003, resulting in a warning letter being issued on May 7, 2003. 82/05/2084 13:85 723-2122 CHILD CARE LICENSURE PAGE — ~~ Administrative Complaint — Exceptional Day Care and The Arts January, 2004 Page 2 4. 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 of a Child Care Tacility. 5, Payment of this fine can be made directly to the Department of Children and Families. The mailing address is: P.O. Box 2417, Jacksonville, FL. 32231, Attention: Child 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 days from the date on which he or she first receives this notice. The requast for hearing must also meet the requirements of Section 120.562, F.S., and either Rule 28-106.201 or Rule 28-106.301, F.A.C., 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. The name, address, and telephone number of the petitioner's representative. if any: 4. Anexplanation 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. Astatement that the petitioner does not dispute the facts upon which the agency relied but that it wante to exercise the right to be heard anyway OR a statement that the patitinner does dispute the facts upon which the agency relied and a list of the facts in dispute; 7. Aconcise statement of the facts as the petitioner percelves them to be, including lhe 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 83 82/5/2884 13:66 723-2122 CHILD CARE LICENSURE PAGE et . Administrative Complaint - Exceptional Day Care and The Arts January, 2004 Page 3 9. Astatement 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 requircd 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 L.D. Williams Paul Founlacker, 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, Suite 407 Jacksonville, FL. 32231 0083 Tallahassee, FL. 32301 STATE OF FLORIDA, DEPARTMENT OF CHILDREN AND FAMILIES re — yy Thomas 8. Ceci Program Administrator a4 2 en 2/95/2984 13:65 723-2122 CHILD CARE LICENSURE PAGE @5 — on Administrative Complaint - Exceptional Day Care and The Arts January, 2004 Page 4 CERTIFICATION OF SERVICE | HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail 7001-2510-0002-5262-9619, Return Receipt Requested, in accordance with $8, 120.60(3), Florida Statutes, this_¢2"__ day of January, 2004. STATE OF FLORIDA, DEPARTMENT OF CHILDREN & FAMILIES Thomas S. Ceci Program Administrator

Docket for Case No: 04-000545