Received: Dec 14 2007 06:01pm Dec 14 O7 O7:16p Dept Childen & Families 9047275519 ; Fo j (nr STATE OF FEORIDA DEPARTMENT OF-CHILDREN AND FAMILIES iN THE MATTER OF Certified Mail 7005 1820 0008 0152 1077 A Civil Penalty Against Return Receipt Requested Gray Family Daycare Home O] - 5S &0 lo ATTN: Reazanda Gray 10248 Manorville Drive Jacksonville, Florida 32221 ADMINISTRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED that the Department has imposed a Civil Penalty in the amount of Fifty Dollars ($50.00). As grounds for the imposition of this penaity, the Department states the following: 4. The Department of Children and Families, State of Florida, has jurisdiction over Respondent by virtue of the provisions of Chapters 402.301 — 402.319, Florida Statutes. 2. The Respondent, Reazanda Gray, is licensed to operate Gray Family Day Care located at 10248 Manorville Drive, Jacksonville, Florida 32221, as a Family Day Care Home in compliance with Chapter 402, Florida Statutes (F.S.), and Florida Administrative Code (F.A.C), Rule 65C-20, 3. During an routine inspection on October 9, 2007, it was determined that the Respondent committed the following violation: FAC Chapter 65C-20.011 (1)(a), in that: Three (3) children’s record were reviewed and did not have a current immunization records. The Family Daycare Operator is responsible for obtaining for each child in care a current, complete and properly executed Florida Certification of Immunization Form 680. Similar violations were cited on March 16, 2006, September 24, 2006, April 9, 2007 and October 9, 2007. A letter of Intent to impose Administrative Action was issued on September 27, 2006 and April 9, 2007. FAC Chapter 65C-20.011 (1) (b) (c), in that: One (1) child, did not have a current health examination... The Family Day Care Operator is responsible for obtaining for each child in care a current, complete and properly executed Student Health Examination Form DH 3040, Similar violations were cited on March 16, 2006, September 24, 2006, April 9, 2007 and October 9, 2007. A letter of Intent to Impose Administrative Action was issued on April 9, 2007. Received: Dec 14 2007 06:01pm Deg 14 O7 O7:16p Dept Childen & Families 9047275519 p-4 ) j Administrative Complaint ~Gray Family Day Care Home Page 2 4. The above referenced violation constitutes grounds to levy 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. 5. Payment of this fine can be made directly to the Department of Children and Family Services. Thé 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 Gregory D. Venz, Agency Clerk Assistant General Counsel Department of Children & Families Department of Children & Families Office of the General Counsel P.O. Box 2417 1317 Winewood Blvd, Bldg. 2, Ste 204 Jacksonville, FL. 32231-0083 Tallahassee, FL. 323014 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 s. 120.57(b}(4), Florida Statutes (2004), 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 s. 120.57(2), FLORIDA STATUTES (2004). 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 7 Received: Dec 14 2007 06:02pm Dec 14 O7 O7:17p Dept Childen & Families 3047275513 } . Administrative Complaint -Gray Family Day Care Home Page 3 which he or she first receives this notice. The request for hearing must also meet the . faquirements of Section 120.56, F.S., and either Rule 28-106.201 or Rule 28-106.301, F.AC., or else it will be dismissed as required by Section 120.569(2)(c), F.S. That law and those rules re quire 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 tele phone number of the person who is asking for the hearing (the petitioner); 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; A statement of when and how the petitioner received notice of the agency decision; 6. Astatement that the that it wants to exerc does dispute the fact petitioner does not dispute the facts upon which the agency relied but ise the right to be heard anyway OR a statement that the petitioner ‘S$ 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, including the specific facts set out by the agency that the petitioner wants the agency to reverse or change; 8. Astatement of the specific rules or Statutes that the petitioner believes requires the agency to reverse or modify its decision; and 9. A statement specif ying 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 natice was first received by the person requesting the hearing: Roger L.D. Williams Gregory D. Venz, 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 P- ‘ Received: Dec 14 2007 06:02pm Dec 14 OF O7:17p Dept Childen & Families 90472755139 7 Administrative Compiaint -Gray Family Day Care Home Page 4 : : STATE OF FLORIDA, DEPARTME} OF CHILDREN AND FAMILIES i | he Pamela Buckham Program Administrator P. Received: Dec 14 2007 06:02pm Dec 14 OF O7:17p Dept Childen & Families 9047275519 CERTIFICATION OF SERVICE | HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, 7005 1820 0008 0152 1077, Return Receipt Requested, in accordance with ss. 120.60(3), Florida Statutes (2005}, this fa day of November 2007. STATE OF FLORIDA, DEPARTMENT OF CHILDREN & FAMILIES ‘Pamela Buckham Program Administrator p- Received: Dec 14 2007 06:020m Dec 14 O7 O7:17p Dept Childen & Families 9047275519 p-8 COMPLETE THIS SECTION ON DELIVERY ; SENDER: COMPLETE THIS SECTION B Complete items 1, 2, and 3. Also complete i item 4 if Restricted Delivery is desired. @ Print your name and address on t! so that we can retumn the card to, ™@ Attach this card to the back of br on the front if space permits. Articis Addressed to: If YES, enter aowery address ‘below: ONo ay Fail : NOV 18 2007! . Gray Family Daycare Hormre- EN & FAMIVES !. ATTN: Peazanda Gray OE LAE LICENSURE 10248 Monorville Drive Jacksonville, Florida 32221 . Service Type © Certified Mail Express Mail © Registered (2 Retum Receipt for Merchandise CG insured Mail" C.0.D. 4. Restricted Delivery? (Extra Fae) 0 Yes \ | ;2 Articla Number ” 1... (Manafer from servi. 7005 1820 aoe guse LO?? PS Form 381 1, February 2004 Domestic 102595-02-M-1540

Docket for Case No: 07-005806