STATE OF FLORIDA DEPARTMENT OF CHILDREN AND FAMIES TGA = 3 Py IN THE MATTER OF A Civil Penalty Against Chuck and Kerry's House 234 Concord Drive Casselberry, Fl 32707 ADMINISTRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED that the Department has imposed a Civil Penalty in the amount of $50 and the facility's license on probation. 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 provisions of sections 402.301- 402.319, Florida Statutes. 2. On November 2, 1985, the Department issued license #C18SE0112 to the respondent to operate Chuck and Kerry’s House, located at 234 Concord Drive, Casselberry, Fl 32707, as a Child Care Facility in accordance with Chapter 402, Florida Statues, and Florida Administrative Code, Rule 65C-22. 3. Respondent committed violation of Rule 65C-22.006(2)(a)-(c) Florida Administrative Code, with respect to children's immunization records. On March 10, 2009, there were two children’s files with missing expiration dates on immunization record. On June 30, 2009, there were eight children’s files with missing expiration dates on immunization record. On October 20, 2009, there was one child’s file with missing expiration date on immunization record. Inspection report for March 10, 2009 is attached as “Exhibit A”. Inspection report for June 30, 2009 is attached as “Exhibit B”. Inspection report for October 20, 2009 is attached as “Exhibit C’. For a violation of children’s immunization records the Department imposes an administrative fine of $25. This fine is imposed in accordance with Section 402.310(1)(a), Florida Statutes. 4. Respondent committed violation of Rule 65C-22.006(2)(a)-(c),(3)(c)3 & 402.305(9) Florida Administrative Code, with respect to children’s health records. On March 10, 2009, there was on expired physical record in child’s file. On June 30, 2009, there were four expired physical records in children’s files. On March 9, 2010, there were two expired physical records in children’s files. Inspection report for March 10, 2009 is attached as “Exhibit A’. Inspection report for June 30, 2009 is attached as “Exhibit B”. Inspection report for March 9, 2010 is attached as “Exhibit D’. For a violation of children’s immunization records the Department imposes an administrative fine of $25. This fine is imposed in accordance with Section 402.310(1)(a), Florida Statutes. 5. The above referenced violations constitute grounds to levy this Civil Penalty pursuant to s. 402.310(1)(a), F. S., 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. PAYMENT OF FINE, IF NOT CONTESTED Payment of this fine can be made by money order or cashier’s check directly to the Department of Children and Family Services. The mailing address is Department of Children and Families; Child Care Licensing Office; 400 W. Robinson Street, North Tower; Suite 201; Orlando, Florida 32801; Attention: Child Care Licensure. IF YOU BELIEVE THE DEPARTMENT'S DECISION IS IN ERROR, YOU MAY REQUEST AN ADMINISTRATIVE HEARING TO CONTEST THE DECISION. YOUR REQUEST FOR AN ADMINISTRATIVE HEARING MUST BE RECEIVED BY THE DEPARTMENT WITHIN 21 DAYS OF YOUR RECEIPT OF THIS NOTICE. FAILURE TO REQUEST AN ADMINISTRATIVE HEARING WITHIN THE 21 DAYS PROVIDED SHALL CONSTITUTE A WAIVER OF THE RIGHT TO A HEARING. You may submit your request for an administrative hearing to the Department at the following address: T. Shane DeBoard, Esquire Department of Children and Families C/O District Legal Office, S-1129 400 West Robinson Street Orlando, Florida 32801-9425 Please note that a request for an administrative hearing must comply with section 120.569(2)(c), Florida Statutes, and Rules 28-106.201(2), Florida Administrative Code. Those provisions, when read together, require a petition for administrative hearing to include: ; (a) The name and address of each agency affected and each agency's file or identification number, if known; (b) The name, address, and telephone number of the petitioner; the name, address, and telephone number of the petitioner's representative, if any, which shall be the address for service purposes during the course of the proceeding; and an explanation of how the petitioner's substantial interests will be affected by the agency determination; (c) A statement of when and how the petitioner received notice of the agency decision; (d) A statement of all disputed issues of material facts. If there are none, the petition must so indicate; (e) Aconcise statement of the ultimate facts alleged, including the specific facts the petitioner contends warrant reversal or modification of the agency’s proposed action; (f) A statement of the specific rules or statutes the petitioner contends require reversal or modification of the agency's proposed action; and (g) A statement of the relief sought by the petitioner, stating precisely the action petitioner wishes the agency to take with respect to the agency's proposed action. Section 120.569, Florida Statutes, and rule 28-106.201(4), Florida Administrative Code, require that a petition to be dismissed if it is not in substantial compliance with the requirements above. STATE OF FLORIDA, . DEPARTMENT OF CHILDREN AND FAMILIES Const. MN. Shoal Carolyn Shdwalter Child Care Licensing Supervisor CERTIFICATE OF SERVICE | HEREBY CERTIFY that a true copy hereof was sent to Kerry Harmelin, Director of Chuck and Kerry’s House 234 Concord Drive Casselberry, Fl 32707, by U.S. Certified Mail, Return Receipt Requested, Certificate # 7007 1490 0002 9044 1161 and by U.S. Regular Mail, in accordance with s. 120.60(3), Florida Statutes, this 75th day of __ april , 2010. T. Shane DeBoard Licensing Attorney Florida Bar No. 0130605 400 West Robinson Street, S-1129 Orlando, Florida 32801 (407) 245-0530

Docket for Case No: 10-003088