STATE OF FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES To: OPK Inc ’ Certified Mail: 7012 3460 0002 3963 6172 d/b/a Orange Park Kindergarten Return Receipt Requested 3050 Moody Avenue 1 , Orange Park, FL 32065 ADMINISTRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED the Department has imposed a Civil Penalty in the amount of Six Thousand Six Hundred Eighty-Five Dollars ($6,685.00). The Department's authority and grounds to impose this sanction are explained below: 1. The Department of Children and Families is authorized by section 402.310, Florida Statutes, to sanction OPK Inc d/b/a Orange Park Kindergarten for violations of child care licensing standards in sections 402.301 — 402.319, Florida Statutes, and chapter 65C-22, Florida Administrative Code. 2. OPK Inc is licensed under chapter 402, Florida Statutes, and chapter 65C-22, Florida Administrative Code, to operate a child care facility known as Orange Park Kindergarten License #C04CL0044 located at 3050 Moody Avenue, Orange Park, FL 32065. The facility license is currently a REGULAR license. Violation #1 3. During a Routine Inspection conducted on September 11, 2014 DCF Licensing Counselor Josephine Walker determined that: The personnel record did not include a signed CF-FSP 5337 Child Abuse and Neglect Reporting Requirements form for one (1) staff member. 4. The foregoing facts violate Florida Administrative Code 65C-22.006(4)(c) which states: CF-FSP Form 5337, March 2009, Child Abuse & Neglect Reporting Requirements, which is incorporated by reference, must be signed annually by all child care personnel. 5. The violation described above is a Class Ill violation of child care licensing standards. It is the facility's third (3) Class Ill violation of Child Care Facility Standards Classifications Summary #59 Personnel Records within a two-year period. The same violation was previously cited on May 16, 2013 at which time they received technical assistance and an administrative waming and on September 5, 2013 they were fined $25.00. The fine imposed for this violation is Twenty-Five Dollars ($25.00). Violation #2 6. During a Routine Inspection conducted on September 11, 2014 DCF Licensing Counselor Josephine Walker determined that: CF-FSP Form 5131, Background Screening and Personnel File Requirements, was not on file for one (1) staff member. 7. The foregoing facts violate Florida Administrative Code 65C-22.006(4)(d) which states: Records shall be maintained and kept current on all child care personnel, as defined by Section 402.302(3), F.S., and household members if the facility is located in a private residence. Screening information must be documented on GF-FSP Form 5131, July 2012, Background Screening and Personnel File Requirements, which is incorporated by reference and may be obtained from the department's website. 8. The violation described above is a Class Il violation of child care licensing standards. It is the facility's third (2"*) Class II violation of Child Care Facility Standards Classifications Summary #60 Background Screening Documents within a two-year period. The same violation was previously 2 cited on May 16, 2013 at which time they received technical assistance and an administrative warning and on September 5, 2013 they were fined $50.00. The fine imposed for this violation is Four Thousand Four Hundred Forty Dollars ($4,440.00) at $60.00 per day for 74 days from May 28, 2014 until September 11, 2014. Violation #3 9. During a Routine Inspection conducted on September 11, 2014 DCF Licensing Counselor Josephine Walker determined that: The Affidavit Of Good Moral Character was not current for staff member C.H. and staff member A. B. form was incomplete. 10. The foregoing facts violate Florida Administrative Code 65C-22.006(4)(d)(3) which states: CF Form 1649A, July 2012, Child Care Affidavit of Good Moral Character, which is incorporated by reference, must be completed for all child care personnel at time of initial screening or upon a change in employers. 11. The violation described above is a Class III violation of child care licensing standards. It is the facility's fourth (4) Class III violation of Child Care Facility Standards Classifications Summary #60 Background Screening Documents within a two-year period. The same violation was previously cited on December 7, 2012 and May 16, 2013 at which time they received technical assistance and an administrative warming, on September 5, 2013 they were fined $25.00. The fine imposed for this violation is Two Thousand Two Hundred Twenty Dollars ($2,220.00) at $30.00 per day for seventy days May 28, 2014 until September 11, 2014. If you do not wish to contest the findings of this administrative complaint, please submit a cashier’s ney 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 CHAPTER 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: 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., Bldg. 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 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 4 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) Astatement 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 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 been furnished by certified mail return receipt no. 7012 3460 0002 3963 6172 to OPK Inc d/b/a Orange Park Kindergarten, 3050 Moody Avenue, Orange Park, FL 32065 this {4 lay of September 2044. Fa A _

Docket for Case No: 14-004990