STATE OF FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES To: Madison Country Day School LLC Certified Mail: 7012 0470 0000 1853 2813 d/b/a Madison Country Day School LLC Return Receipt Requested 405 SW Pinckney Street Madison, FL, 32340 ADMINISTRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED the Department has imposed a Civil Penaity in the amount of Five Hundred Dollars ($500.00) and Suspension of Child Care License for 5 days. The Department’s authority and grounds to impose this sanction are explained below: 41. The Department of Children and Families is authorized by section 402.310, Florida Statutes, to sanction Madison Country Day School LLC, d/b/a Madison Country Day School LLC for violations of child care licensing standards in sections 402.301 — 402.319, Florida Statutes, and chapter 65C-22, Florida Administrative Code. 2. Madison Country Day School LLC is licensed under chapter 402, Ftorida Statutes, and chapter 65C-22, Florida Administrative Code, to operate a child care facility known as Madison Country Day School LLC located at 336 N Washington Avenue, Madison, FL 32340. The facility license is currently a REGULAR license. 3. During a Routine Inspection on February 6, 2013 & February 14, 2013, licensing counselor Donna Giebeig, determined that: The ground cover or other protective surface under the swings, monkey bars and permanent place equipment was not maintained. 4. The foregoing facts violate Administrative code 65C-22.002(9)(b)3 Permanent or stationary playground equipment must have a ground cover or other protective surface under the equipment that provides resilience, and is maintained to reduce the incidence of injuries to children in the event of falls. 5. The violation described above is a Class III violation of child care licensing standards. These are the facility's Sixth and Seventh Ill violations of Child Care Facility Standards Classification Summary # 40 (fall zone) within a two-year period. The same violation was cited on November 16, 2012 (technical assistance was provided), December 10, 2012(technical assistance was provided), January 9, 2013(resulting in Administrative Complaint for $25), January 16, 2013(resulting in Administrative Complaint for $240), and January 28, 2013(resulting in Administrative compiaint for $280 and probation). The fine imposed for this violation is Five Hundred Dollars ($500.00) and Suspension of Child Care License for 5 days ($50 per day for 10 days from February 6, 2013 until February 20, 2013). (f you do not wish to contest the findings of this administrative complaint, please submit a cashier's check or money order_made payable to the Florida Department of Children and Families, Child Care Regulation Office, 5920 Arlington Expressway, P.O. Box 2417, Jacksonville, FL 32231 if you wish to contest the findings of this administrative complaint and/or the sanctions imposed, you may do so as provided in the notification of rights below. NOTIFICATION OF RIGHTS UNDER GHAPTER 120, FLORIDA STATUTES 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 IN WRITING AND 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 addresses: Lucy Goddard-Teel Gregory D. Venz, Agency Clerk Assistant Regional Counsel Department of Children & Families Department of Children & Families Office of the General Counsel 1000 NE 16 Avenue, Bldg. J #3 1323 Winewood Bivd., Bidg. 1, Suite 407 Gainesville, FL. 32601 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 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; {c) An explanation of how the petitioner's substantial interests will be affected by the agency determination; (d) A statement of when and how the petitioner received notice of the agency decision; (e) A statement of all disputed issues of material facts. If there are none, the petition must so indicate; (f) Aconcise statement of the ultimate facts alleged, including the specific facts the petitioner contends warrant reversal or modification of the agency's proposed action; (g) A statement of the specific rules or statutes the petitioner contends require reversal or modification of the agency's proposed action, including an explanation of how the alleged facts relate to the specific rules or statutes; and (h) A statement of the relief sought by the petitioner, stating precisely 3 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 a petition to be dismissed if it is not in substantial compliance with the requirements above. Mediation as described in section 120.573, Florida Statutes, may be available if agreed to by all parties, and on such terms as agreed to by all parties. The right to an administrative proceeding is not affected when mediation does not result in a settlement. CERTIFICATE OF SERVICE | HEREBY CERTIFY that a true and correct copy of the foregoing has bee ‘urnished by certified mail retum receipt no. 7012 0470 0000 1853 2813 to Ma iso Country Day bs hyo! LLC located/at 336 N Washington Avenue, Madison, FL 32340., this ¢ thay of March, 2013.

Docket for Case No: 13-001495