O, 9 ee STATE OF FLORIDA * DEPARTMENT OF CHILDREN AND FAMILIES 4b “ 2, fA On. by Ceenhen MAK vlc 4, Vp, , IN THE MATTER OF VOUT 3G0D COIO Wogan m2 29 A Civil Penalty Against oe . CATHERINE B. HERBRUCK, d/b/a TOMOKA KID CONNCETION 999 Old Tomoka Road Ormond Beach, Florida 32174 OY-33*2 ADMINISTRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED that the State of Florida, Department of Children and Families, (hereinafter “the department”) has imposed an administrative fine upon you in the amount of Fifty dollars ($50.00). As grounds for imposition of this penalty, the department states as follows: 1. The department has jurisdiction to impose this administrative fine pursuant to Section to Section 402.310, Florida Statutes; 2. Respondent CATHERINE B. HERBRUCK is the Owner and Director of TOMOKA KID CONNECTION. Her home address is 18 Timber Trail, Ormond Beach, Florida 32714. 3. Respondent CATHERINE B. HERBRUCK, is licensed to operate a child care facility d/b/a TOMOKA KID CONNECTION at 999 Old Tomoka Road, Ormond Beach, Volusia County, Florida, 32714, under DCF Provisional License Certificate Number C12V00163, expiring July 2, 2004; 4, Respondent is required to operate said facility in accordance with Chapter 402, Florida Statutes, and Chapter 65C-22, Florida Administrative Code; 5. Respondent has committed the following violations of Chapter 402, Florida Statutes, and/or Chapter 65C-22, Florida Administrative Code: a. On or about December 3, 2003, an authorized agent of the Department conducted an inspection of Respondent’s facility. While at Respondent’s facility, the authorized agent of the Department, while reviewing Respondent’s personnel files, noted that there was no file available for inspection for Respondent’s new employee M.A. Respondent was missing an Abuse and Neglect form and a Supplemental Employment Application for employee M.A. Respondent was provide written notification of the deficiency on December 3, 2003. Thereafter, on April 6, 2004, an authorized agent of the Department conducted an inspection of Respondent’s facility. On that date, the authorized agent determined that Respondent’s employee personnel files for Respondent’s employees M.A. and K.C. were not within Respondent’s facility, and therefore were unavailable for review. Further, Respondent failed to provide proof of having completed background screening for Respondent’s employee M.A. Respondent’s continued failure to maintain employee personnel files, and to secure documentation of background screening for her employee M.A., constitutes a violation of Rule 65C-22.006, Florida Administrative Code (2003). b. For the above-listed violation, the following fine is imposed: a. For the violations occurring on April 4, 2004, in 5.a. above, Fifty dollars ($50.00); For a total of Fifty dollars ($50.00). Payment of this fine can be made directly to the Department of Children and Families. The mailing address is 210 North Palmetto Avenue, Suite 440, Daytona Beach, Florida 32114, Attn: District Administration. Please be advised that you do have the right to contest this Civil Penalty through an administrative hearing, pursuant to Section 120.57, Florida Statutes, but that you have no more than fifteen (15) days from the date this Administrative Complaint is received to make a written request for this formal review. To initiate the formal review >rocess, the following individual within the fifteen- (15) day time frame must receive a petition fora formal hearing which complies with Rule 28-106.201, Florida Administrat:ve Code, a copy of which is attached hereto as ATTACHMENT I: Betsy Lewis, Acting District Administrator Department of Children and Families 210 North Palmetto Avenue Suite 440 Daytona Beach, Florida 32114 No later than fifteen (15) days after receipt of your written request for a formal hearing, the request for a hearing shall be granted or denied. Absent the consent of all parties, the hearing will not commence on fewer than fourteen- (14) days notice. Finally, in accordance with Section 120.57(b)(4), Florida Statutes (2001), all parties to this cause have the opportunity to respond, to present evidence and argumert of all issues involved, to conduct cross-examination and submit evidence, to submit proposed findings of fact and order, to file exceptions to any order or hearing officer’s recommended order, and to be represented by counsel (at your own expense). In addition, you have the right to have subpoenas duces tecum issued. If mediation is available to resolve this dispute and should you choose to mediate, your right to a hearing will not be waived. Acting District Administrator Department of Children and Familics, District 12 210N. Palmetto Avenue Daytona Beach, FL 32114 5] fe Y DATE

Docket for Case No: 04-003282