Herel Ftut Foot Pent _ STATE OF FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES IN THE MATTER OF Certified Mail 7003-1680-0000-0502-1645 Civil Penalty Against Return Receipt Request Jean Johnson, Director Jacksonville Urban League 8000 Arlington Expressway, Suite 600 Jacksonville, Florida 32211 C Y ; U f Uy | ADMINISTRATIVE COMPLAINT : soe YOU ARE HEREBY NOTIFIED that the Department. has imposed a Civil Penalty in the” amount of One Hundred Dollars ($100.00). 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 the Respondent by virtue of the provisions of Chapters 402.301 ~ 402.319, Florida Statutes. 2. The Respondent, Jacksonville Urban League, is licensed to operate Head Start at Forest Park located at 2037 Forest Street, Jacksonville, Florida 32210, as a child care facility in compliance with Chapter 402, Florida Statutes (F.S.), and Florida Administrative Code (F.A.C), Rule 65C-22. 3. During an investigation on August 27, 2004, it was determined that the Respondent committed a Class I violations, FAC Chapter 65C-22.001(8)(a and b), In that: On August 12, 2004, a three-year-old child was grabbed by a teacher, leaving a bruise on the child's arm which was still visible on August 25, 2004. An agency, acting as 4 consultant for the Department, examined the mark on the child’s arm and determined that the mark was diagnostic of abuse. The child was interviewed by this consulting agency and by another investigative unit of the Department. Both agencies found that the child's history was consistent that a teacher in her classroom grabbed her arm and would not let her go. 4. The above referenced violations constitute grounds to levy this Civil Penalty pursuant to ss.402.310(1)(a) and 402.310(4), 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 Facility. ca DV BANSNSOIT Savo THO Za Le-Ead EGtTL pabe/eb/eT Administrative Complaint Jacksonville Urban League - Head Start at Forest Park October, 2004 Page 2 5, Payment of this fine can be made directly to the Department of Children and Family Services. The mailing address is: P.O. Box 2417, Jacksonville, FL. 32231, Attention: Child Care Licensure. : 6, 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 twenty one (21) days from the date the Administrative Complaint is received to initiate this formal review. To initiate this formal review process, a petition for formal hearing must be received by the following individuals within the twenty-one-day time frame: Roger L.D, Williams Paul Flounlacker, Agency Clerk Assistant General Counsel Department of Children & Families Department of Children & Famities Office of the General Counsel P.O. Box 2417 1317 Winewood Bivd., Bidg. 2, Ste 204 Jacksonville, FL. 32231-0083 Tallahassee, FL. 32301 No later than fifteen (15) days after receipt of your written request for a format hearing, the request for a hearing shail 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 s. 120.57(b)(4), Florida Statutes (2003), all parties to this cause have the opportunity to respond, to present evidence and argument of all Issues of involved, to conduct cross-examination and submit evidence, to submit proposed findings of facts and order, to file exceptions to any order of a hearing officer's recommended order, and to be represented by counsel (at your expense). In addition, you have the right to have subpoenas and subpoenas duces tecum issued. Your request for an administrative hearing must state what issues and material facts you dispute, or It will be dismissed. FAILURE TO DISPUTE MATERIAL ISSUES OF FACT IN YOUR REQUEST FOR A HEARING MAY BE TREATED BY THE DEPARTMENT OF CHILDREN AND FAMILY SERVICES AS AN ELECTION BY YOU FOR THE INFORMAL PROCEEDINGS UNDER 5. 120.57(2), FLORIDA STATUTES (2000). Ea FN SaNSNS31I7 Sav OIIHO Ge 1le-8e2 EG:TL peace /sasal Administrative Complaint Jacksonville Urban League - Head Start at Forest Park October, 2004 Page 3 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 !s received within twenty-one days from the date on which he or she first receives this notice. The request for hearing must also meet the requirements of Section 120.56, F.S., and elther 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 Jaw 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 petitloner): 3. The name, 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. Astatement 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 ayency 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 retied and a list of the facts in dispute; 7. Aconcise 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. 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 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. pa FBV SSNSN3II7 Sav dTIHO E22 TE~ESL EG:1T pbUeZ/Bb set Administrative Complaint Jacksonville Urban League - Head Start @ Forest Park October, 2004 Page 4 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 recelved by the person requesting the hearing: Roger L.D. Williams Paut Flounlacker, Agency Clerk Assistant General Counsel Department of Children & Famities Department of Children & Familles Office of the Genera! 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 n Ip— Linda '‘N. Smith Program Administrator 9a 35Vd SANSNSOID Sav THOS OTS ESL Ea:TT bBb2/8B/oT Administrative Complaint Jacksonville Urban League - Head Start at Forest Park October, 2004 Page 5 CERTIFICATION OF SERVICE L HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail 7003-1680-0000-0502-1645, Return Receipt Requested, in accordance with ss. 120.60(3), Florida Statutes (2003), this va day of @ctuber, 2004. Noy STATE OF FLORIDA, DEPARTMENT OF CHILDREN & FAMILIES — . Linda N. ith Program Administrator 9a FbVd BANSNSOIT Sava TTIHO G21e-ESL EG:TT paaa/Be/ct

Docket for Case No: 04-004641