STATE OF FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES \N THE MATTER OF Certified Mail 7009 3410 0001 6528 2116 A Civil Penalty Against Reium Receipt Requested Northside Community Involvement, Inc. 4736 Avenue B Jacksonville, Florida 32209 DMINISTRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED that the Department has imposed a Civil Penalty in the amount of Twelve Hundred Dollars ($1,200.00), against Northside Community Involvement, inc. The Department is recommending Revocation of the license under which said Respondent operates its Child Care Facility. 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 this matter by virtue of the provisions of Sections 402.301 — 402.319, Florida Statutes. 2. The Respondent, Northside Community Invoivement, Inc. , is licensed to operate Northside Community Involvement-License # C04DU0317 located at 4736 Avenue B , Jacksonville, Florida, 32209 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 August 24, 2010, a DCF Licensing Counselor determined that: Documentation of Level 2 Background Screening and Personnel File Requirements (CF-FSP Form 5131) was not on file for staff member P.P., hired July 26, 2010. 4. FAC Rule 65C-22.006 (4), records shal! be maintained and kept current on all childcare personnel, as defined by Section 402.302 (3), F.S. A screening conducted under this rule is valid for five years at which time a statewide re-screening must be conducted. A person in this five (5) year re-screen category must undergo, at a minimum a statewide criminal records checks through the Florida Department of Law Enforcement and a Iocal criminal records check. Pursuant to the Florida Administrative Code Rule 65C-22.006 (4), this is a Class 2 violation. This same Class 2 violation was previously cited on December 8, 2009 and May 27, 2010. Pursuant to the Child Care Facility Standards Classification Summary, CF-FSP Form 5316, Item # 60-Background screening and personnel file requirements, the fine for this third Class 2 violation is $60.00 per day for a total of ten (10) days, totaling $600.00, the Background Screening and Personnel Form CF-FSP 5131 was received via a fax on September 7, 2010. Violation-Il 5. During an inspection on August 24, 2010, a DCF Licensing Counselor determined that: One (1) or more children were not adequately supervised in that on August 17, 2010 a two (2) year old child (D.C.) who was under the supervision of the facility for that day was allowed to leave the facility and remain outside of the facility on the playground, for at least fiftean (15) minutes between 5:15p.m. and 5:45 p.m., which was anticipated as posing a threat to the health, safety or well being of a child. 6. FAC Rule 65C-22.001 (5) (a) (a), direct supervision means watching and directing children’s activities within the same room or designated outdoor play area and responding to the needs of each child. Childcare personnel at a facility must be assigned to provide direct supervision to a specific group of children and be present with that group at all times. When caring for school age children, childcare personnel shall remain responsible for the supervision of the children in care and capable of responding to emergencies, and are accountable for children at all times, including when children are separated from their groups. Pursuantto the Florida Administrative Code Rule 65C-22.001 (5) (a) {d), this is a Class 1 violation, Pursuant to the Child Care Facility Standards Classification Summary, CF-FSP Form 5316, Item #5- Inadequate direct supervision, the fine for this first Class 4 violation is not less than $100.00 nor more than $500.00 per day. In addition, the Department may impose other disciplinary action in addition to the fine. Therefore, the fine is being assessed In the amount of $500.00, due to the child was left unattended outside for about fifteen (15) minutes. Violation-il 7. During an inspection on August 24, 2010, a DCF Licensing Counselor determined that: Facility was observed to be out of ratio, In that there ware three (3) staff members with a mixed group of twenty (20) children. Observed were ten (10) one year olds and ten (10) two year old children. Four staff members are required in order to meet the ratio requirements when one year old children are present In the group of this size. 8 FAC Rule 65C-22.004 (4) (a) (b), states, that staff to child ratio, as established in 8.402.305 (4), F.S. is based on primary responsibility for the direct supervision of children and applies at all times while children in care. In groups of mixed ranges, where children one (1) year of age but under two (2) year of age are included, one (1) staff member shall be responsible for no more than six (6) children of any age group, at all times. Pursuant to the Florida Administrative Code Rule 66-22,001 (4) (a) (b0, this is a Class 2 violation. This same Class 2 violation was previously cited on December 8, 2009, January 21, 2010 and February 10, 2010, Pursuant to the Child Care Facillty Standards Classification Summary, CF-FSP Form 5316, ltem #4-Insufficient staff, the fine for this fourth Class 2 violation is $75.00. In addition to the fine levied above the Respondent’s License will he REVOKE. As this Is their 6" Class 1 violation, the third subsequent and Class 1 violation the Department shall suspend, deny or revoke the license. The Department has determined to REVOKE the license, due to the history of Class 1 violations of the same standard within a two year period. 9. The above referenced violation constitutes grounds to levy this Civil Penalty pursuant to $8.402.310(1)(a) and 402.310(4), Florida Statutes as the above referenced conduct of Respondent constitutes a violation of the minimum standards, rules and regulations for the operation of a Chitd Care Factlity. 10. Payment of money order or cashier's check for this fine can be made directly to the Department of Children and Family Services. The mailing address {s: 5920 Arlington Expressway, P.O. Box 2417, Jacksonville, FL. 32234, Attention: Child Care Licensure. 11. 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 NOTIFICATION OF RIGHTS UNDER CHAPTER 120, FLORIDA STATUTES IF YOU BELIEVE THE DEPARTMENT'S DECISION IS {N ERROR, YOU MAY REQUEST AN ADMINISTRATIVE HEARING TO CONTEST THE DECISION. YOUR REQUEST FOR AN ADMINISTRATIVE HEARING MUST BE RECEIVED BY THE DEPARTMENT WITHIN 27 CALENDAR 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 addresses: . David Tucker Gregory D. Venz, Agency Clerk Chief Legal Counsel Department of Children & Families Department of Children & Families ‘Office of the General Counse| P.O, Box 2417 1323 Winewood Bivd., Bidg. 1, Suite 407 Jacksonville, FL, 32231-0083 Tallahassee, FL. 32301 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; (bo) 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) Astatement 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 petitlon must so Indicate; {e) A concise 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. Pursuant to section 120.573, Florida Statutes, the Department advises that formal mediation is not available for this administrative complaint. However, the Department may consider proposals to resolve the. complaint without a formal hearing. STATE OF FLORIDA, DEPARTM ye CHILDREN AND FAMILIES Pamela Buckham 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, 7009 3410 0001 6528 2116, Return Receipt Requested, in accordance with ss. 120.60(3), Florida Statutes (2005), this 3077tay of November, 2010. STATE OF FLORIDA, T OF CHILDREN & FAMILIES Pgmela Buckham SAfety Program Manager

Docket for Case No: 11-001805