STATE OF FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES Augustina Academy Inc. 1507 N Pine Hills Road Orlando, FL 32808 Certified Mail Return Receipt No. 0/4 2/20 0003 2 YSP- 523¢ ‘tt OM YOU ARE HEREBY NOTIFIED the Department has imposed a Civil Penalty in the amount of $250.00. 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 Augustina Academy Inc. for violations of child care licensing standards in sections 402.30] — 402,319, Florida Statutes, and chapter 65C-22, Florida Administrative Code. 2, Augustina Academy Inc., is licensed under chapter 402, Florida Statutes, and chapter 65C- 22, Florida Administrative Code, to operate a child care facility located at 1307 N Pine Hills Road, Orlando, FL 32808. The facility license is currently regular annual license, 3, Respondent committed a Class 1 violation of s,402.305(2)(a) Florida Statutes, with respect to supervision. On May 4, 2015, unscreened individuals were left alone to supervise children in care. The inspection for May 4, 2015 is attached as Exhibit “A”. For this violation, the Department imposes a & $250 fine which is imposed in accordance with Section 402.310(10)(a), Florida Statutes. 4. The foregoing facts violate s.402.305(2\a) Florida Statutes. 5. The violation described above is a Class I violation of child care licensing standards, It is the facility’s first class | violation of supervision requirements within a two-year period. The fine imposed for this violation is $250. If you do not wish to contest the findings of this administrative complaint, payment of the fine amount may be made directly to the Florida Department of Children and Families, Child Care Regulation Office by money order or cashier’s check. The mailing address is: Department of Children and Families Attention; Child Care Regulation 400 West Robinson Street S-929 Orlando, Florida 32801 If you wish to contest the findings of this administrative complaint, 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: Stefanie Camfield Department of Children and Families C/O District Legal Office, S-1129 400 West Robinson Street Orlando, Florida 32801-9425 Please note 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 wil] 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} 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; (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 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 THEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by certified mail return receipt to Augustina Peasah, Owner of Augustina Academy Inc. located at 1307 N Pine Hills Road, Orlando, FL 32808, this 3rd day of June, 2015. Cl t Child Care Regulation Supervisor

Docket for Case No: 15-004379