STATE OF FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES To: Lutheran Services Florida inc dib/a Certified Mail: 7012 3460 0002 3963 6523 Lutheran Services Florida inc Rufus E Payne Return Receipt Requested Elementary Head Start 6725 Hema Rd Jacksonville, FL 32209 ADMINISTRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED the Department has imposed a Civil Penalty in the amount of One Hundred Dollars ($100.00). 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 Lutheran Services Florida Inc d/b/a Lutheran Services Florida Inc Rufus E Payne Elementary Head Start for violations of child care licensing standards in sections 402.301 — 402.319, Florida Statutes, and chapter 65C-22, Florida Administrative Code. 2. Lutheran Services Florida Inc is licensed under chapter 402, Florida Statutes, and chapter 65C-22, Florida Administrative Code, to operate a child care facility known as Lutheran Services Florida inc Rufus E Payne Elementary Head Start License #C04DU1100 located at 6725 Hema Rd, Jacksonville, FL 32209. The facility license is currently a REGULAR License. 3. During a Complaint Investigation on August 25, 2014 DCF Licensing Counselor Tracey Flanders, determined that: A child was not adequately supervised and left the facility premises without the knowledge or awareness of staff members. On August 19, 2014 a child K.S. left the facility on a bus to ride home, however this child is not a bus rider and was on the bus for 50 minutes. Staff member S.M. was unaware that the wrong child was on the bus until his mother arrived at the facility to pick him up. Staff member S.M. states that they mixed up K.S. with another child that is a bus rider. 1 4. The foregoing facts violate Florida Administrative Code 65C-22.001(5)(a) which states: Direct supervision means actively watching and directing children’s activities within the same room or designated outdoor play area, and responding to the needs of each child. Child care personnel at a facility must be assigned to provide direct supervision to a specific group of children, and be present with that group of children at all times. When caring for school-age children, child care personnel shall remain responsible for the supervision of the children in care, shall be capable of responding to emergencies, and are accountable for children at all times, including when children are separated from their groups. 5. The violation described above is a Class I violation of child care licensing standards. It is the facility's first (1°) Class | violation of Child Care Facility Standards Classifications Summary #5 Supervision within a two-year period. The fine imposed for this violation is One Hundred Dollars ($100.00). {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 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 Chief Legal Counsel Department of Children & Families P. O. Box 2417 Jacksonville, FL. 32231-0083 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 (b) (d) (e ~ 1) (g) agency's file or identification number, if known; 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; An explanation of how the petitioner's substantial interests will be affected by the agency determination; A statement of when and how the petitioner received notice of the agency decision; A statement of all disputed issues of material facts. If there are none, the petition must so indicate; 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; Astatement of the specific rules or statutes the petitioner contends require reversal or modification of the agency's preposed action, including an explanation of how the alleged facts 3 telate 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. | HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by certified mail return receipt no. 7012 3460 0002 3963 6523 to Lutheran Services Florida Inc d/b/a Lutheran meaty) Florida Inc Rufus E Payne Elementary Head Start, 6725 Hema Rd, Jacksonville, FL 32209 this. Gh day of November 2014. J i oe i bee . [Sate Buckham {Safety Prograrh M Manager

Docket for Case No: 14-006057