STATE OF FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES 09 EE ge 0 "ge IN THE MATTER OF Certified Mail 7005 1820 0008 0152 1664-7 20 Pit, A Civil Penalty Against Return Receipt Requested OY 12 ? Country Bumpkins Childcare, Inc. ~ 10805 Old Gainesville Road () 1: > ( ( a Jacksonville, Florida 32214 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 penalty, the Department states the following: 4. The State of Florida, Department of Children and Families (DCF) has L jurisdiction over Respondent by virtue of the provisions of Sections 402.301 — 402.319, Florida Statutes. 2. The Respondent, County Bumpkins Childcare, Inc., is licensed to operate Country Bumpkins Childcare -License # CO4DU 0118, located at 10805 Old Gainesville Road, Jacksonville, Florida 32211, as a Child Care Facility in compliance with Chapter 402, Florida Statutes (F.S.), and Florida Administrative Code (F.A.C), Rule 65C-22. Violation 3. During an inspection on September 11, 2009, a DCF Licensing Counselor determined that: The facility did not complete the employment verification for staff member K.O., hired June 1, 2009, on all employers within the last two (2) years. 4. FAC Rule 65C-22.006 (4), states, Level 2 Background Screening includes an Employment History Check that includes the previous two (2) years. An Employment History Check conducted under this rule shall include the applicant's position description, confirmation . of employment dates from previous job (s) and level of job performance. Pursuant to Administrative Code Rule 65C-22.006 (4), this is a Class 2 violation. This same Class 2 violation was previously cited on September 29, 2008. Pursuant to Progressive Disciplinary Sanctions Summary Item # 60-Background Screening, the fine for this second Class 2 violation is $50.00. 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. 6. Payment of this fine can be made directly to the Department of Children and Family Services. The mailing address is: 5920 Arlington Expressway, P.O. Box 2417, Jacksonville, FL. 32231, Attention: Child Care Licensure. 7. Failure to pay the fine imposed in this Administrative Complaint will result in an automatic non-renewal of the license referenced above. 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: 4. 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. Astatement that the petitioner does not dispute the facts upon which the agency i i | i 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; 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 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 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 41323 Winewocd Blvd., Bldg. 1, Suite 407 Jacksonville, FL. 32231-0083 Tallahassee, FL. 32301 STATE OF FLORIDA, : | | | DEPARTMENT)OF CHILDREN AND FAMILIES bine i Pamela Buckham Safety Program Manager ay 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 1664, Return Receipt Requested, in accordance with ss. 120.60(3), Florida Statutes (2005), this /$7day of October, 2009. STATE OF FLORIDA, DEPARTMENT OF CHILDREN & FAMILIES } at [oan Pamela Buckham Safety Program Manager

Docket for Case No: 09-005772