2 a STATE OF FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES IN THE MATTER OF Certified Mail 7001-2510-0001-0883-1852 A Civil Penalty Against Return Receipt Requested Theresa Levy _. ; Jewish Community Alllance ne ao) | 8505 San Jose Blvd. Od \o5 Jacksonville, Florida 32217 ADMINISTRATIVE COMPLAINT g br YOU ARE HEREBY NOTIFIED that the Department has imposed a Civil Penalty in “Ahe 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 Respondent by virtue of the pravisions of Chapters 402.301 ~ 402.319, Florida Statutes, 2. The Respondent YM-YMHA of Greater Jacksonville, Inc., is licensed to operate Jewish Community Alliance located at 8505 San Jose Bivd., Jacksonville, Florida 32217, 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 inspection on February 14, 2005, it was determined that the Respondent committed the following violation, FAC Chapter §5C-22.003(2}(a}-(e) & 402.305(2) in that: Three staff members; D.G., hired August 1, 2004, R.L., hired August 16, 2004 and M.M., hired March 27, 2004, did not have documentation to show enrollment in the 40 hour Introductory Course in Child Care. They had been employed for more than 90 days. This violation was Previously cited on April 4, 2003, June 11, 2003 and again on February 23, 2004. A Notice of Intent to Impose Administrative Action was issued on February 23, 2004, 4. Staff members D.G., hired August 1, 2004, H.K., hired August 2, 2004, M.M, hired March 27, 2004, and 8.S., hired October 28, 2004, all needed FBI Clearance letters in their personnel file. [Level 2 background Screening of new child care personnel consists of, but is not limited to: An Affidavit of Good Moral Character completed prior to employrnent and annually thereafter; and a request for a Sheriff's Office Record Check and the submission of a fingerprint card to the appropriate agencies within ten days of employment.] Failure to do this is in violation of FAC 65C-22.006(5)(d) & 435.04. 61SS2Z24+06 Ser[Twej B UePTTYD reg dorizt SO 22 ~eW sI° Administrative Complaint - jewish Community Alliance Page 2 This violation was previously cited on Aprif 24, 2003 and February 23, 2004. A Notice of Intent to Impose an Administrative Action was issued on February 23, 2004, 5. The above referenced violation constitutes grounds to fevy this Civil Penalty Pursuant to ss.402,310(1)(a) and 402.310(4), Florida Statutes at the above referenced conduct of Respondent constitutes a violation of the minimum standards, rules and regulations for the operation of a Child Care Facility. 6. 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. 7, Please be advised that you do have the right to contest this Clvil Penalty through an administrative hearing pursuant to Section 120.57, Florida Statutes, but that you have no more than twenty one (21) cays 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 Joseph S. Garwood, Agency Clerk Assistant Genera! Counsel Department of Children & Families Department of Children & Families Office of the General Counsel P.O. Box 2417 1317 Winewood Bivd., Bldg. 2, Ste 204 Jacksonville, FL. 32231-0083 Tallahassee, FL. 32301 No later than fifteen (1 5) 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 s. 120.57(b)(4), Florida Statutes (2003), all parties to this Cause have the Opportunity to respond, to present evidence and argument of ali 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 officers 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 S$, 120.57(2), FLORIDA STATUTES (2000). 61SS224+06 satrrwes 3 uapTtug adag dovizt SO 22 EW st° Administrative Complaint - Jewish Community Alliance Page 3 OTICE HTS This decision constitutes fina! agency action unless a person who is substa tally by it submits a written request for hearing that is received within twenty-ofie days fri the date on which he or she first receives this notice. The request for hearing mst also meet the requirements of Section 120.56, F.S., and either Rule 28-106.201 or Rule 28- 106.301, F.A.C., or else it will ba 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. An explanation of how the petitioner's substantial interests are or will be affected by the agency decisian; 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 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. Aconcise statement of the facts as the petitioner perceives them to be, i ncluding 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. The request must be recelved 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: 6ISSL22606 SatiTtwe4y % uapTtug adeg dov:at so g2 Yew 2qt* Roger L.D. Williams Assistant Genera! Counsel Joseph S. Garwood, Agency Clerk Department of Children & Families Department of Children & Families Office of the General Counsel P.O. Box 2417 1323 Winewood Blvd., Bldg. 1, Suite 407 Jacksonville, FL. 32231-0083 Tallahassee, FL. 32301 STATE OF FLORIDA, 61SSA¢c2+06 DEPARTMENT OF CHILDREN AND FAMILIES / ° . ne Andrea J. Tracin Program Administrator satTiwey 8 uePITUg sdeg divizt SO 22 4eW

Docket for Case No: 05-001334