64-SOTY . STATE OF FLORIDA E fd gm DEPARTMENT OF CHILDREN AND FAMILIES £009 IN THE MATTER OF Certified Mail 7005 1820 0008 01 Bday A Civil Penalty Against Return Receipt Requested DLC Nurse & Learn, inc. page 4101-1 College Street § Ibe Jacksonville, Florida 32205 ADMINISTRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED that the Department has imposed a Civil Penalty in the amount of Fifty Dollars ($ 0.00). As grounds for the imposition of this penalty, the Department states the following: 1. The State of Florida, Department of Children and Families (DCF) has jurisdiction over Respondent by virtue of the provisions of Sections 402.301 — 402.319, Florida Statutes. 2. The Respondent, DLC Nurse & Learn, Inc. , is licensed to operate DLC Nurse & Learn, inc. located at 4101-1 College Street, Jacksonville, Florida, 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 a renewal inspection on July 22, 2009 , a DCF Licensing Counselor determined that the Respondent did: The employment verification for staff member E.H., hired May 8, 2009 did not include all of the employers from the past two (2) years listed on her Employment History Form. 4. FAC Rule 65C-22.006 (4), states, An Employment History Check shall include the previous 2 years of experience, the applicant's position description, confirmation of employment dates from previous job (s), and level of job performance. Pursuant to Florida Administrative Code Rule 65C-22.006 (4), this is a Class 2 violation. This same Class 2 violation was ‘previously cited on November 13, 2008. Pursuant to the Progressive Disciplinary Sanctions Summary item # 60-Background Screening, the fine for this second Class 2 violation is $50.00. ~ Op ~P #93 Administrative Complaint-DLC Nurse & Leam Page 2 5. 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. 8. Payment of this fine can be made directly to the Depariment of Children and Family Services. The mailing address is: P.O. Box 2417, Jacksonville, FL. 32231, Attention: Child Care Licensure. NOTICE OF RIGHTS 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 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 request for hearing must also meet the requirements of Section 120.57, F.S., and either Rule 28-106.201 Florida Administrative Code or else it will be dismissed as required by Section 120.569(2)(c), Florida Statutes. The statute and 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 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 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, including the Specific facts set out by the agency that the petitioner wants the agency to reverse or change; ; Administrative Complaint-DLC Nurse & Learn Page 3 8. A statement of the specific rules or statutes that the petitioner believes requires the agency to reverse or modify its decision; and 9. A statement 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 fo 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: David Tucker Gregory D. Venz, Agency Clerk Chief Legal Counsel Department of Children & Families Department of Children & Families Office of the General Counsel P.O. Box 2417 1323 Winewood Blvd., Bidg. 1, Suite 407 Jacksonville, FL. 32231-0083 Tallahassee, FL. 32301 STATE OF FLORIDA, DEPARTMENT OF CHILDREN ANDFAMILIES Pamela Buckhnam Safety Program Manager 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 5068, Return Receipt Requested, in accordance with ss. 120.60(3), Florida Statutes (2005), this J§74ay of August , 2009. STATE OF FLORIDA, DEPART OF CHILDREN & FAMILIES Pamela Buckham Safety Program Manager

Docket for Case No: 09-005078