STATE OF FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES To: Lutheran Services Florida Inc Certified Mail: 7012 3050 0002 0677 3425 d/b/a Lutheran Services Florida Inc Return Receipt Requested Rufus E Payne 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 Seven Hundred Fifty Dollars ($750.00) and SUSPENSION OF THE GHILD CARE LICENSE FOR FIVE (5) BUSINESS DAYS. 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 #C04DU1 100 located at 6725 Hema Rd, Jacksonville, FL 32209. The facility's license is currently a REGULAR License. Violation #1 3. During a Complaint Investigation on June 29, 2015 DCF Licensing Counselor Latonjia Jones determined that: One or more children were not adequately supervised in that a three (3) year old child J.P. was found wandering down the street approximately 456 ft. from the child care facility which posed an imminent threat to a child, or could or did result in death or serious harm to the health, safety or well-being of a child. J.P. left the facility and was found wandering down the street crying for his mommy for approximately 30 minutes. The child was returned to the facility by an unknown individual who found him. Staff assigned to supervise J.P. were unaware he had left the facility until he was returned. 4. The foregoing facts violate Florida Administrative Code 65C-20.001(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 ta 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 | 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 Five Hundred Dollars ($500.00). Violation #2 6. During a Compiaint Investigation on June 29, 2015 DCF Licensing Counselor Latonjia Jones determined that: As a mandated reporter, the owner, operator, employee or substitute failed to report suspected child abuse or neglect as required in section 39.201, Florida Statutes. Staff members S.M. and T.H. and the director S.M. were aware of the incident and failed to report it to the Abuse Hotline. The Director, S.M. and staff S.M. and T.H. worked all day from approximately 9:05 a.m. — 4:30 p.m. and did not notify the proper agency that a three (3) year old child had been missing from the child care center. 7. The foregaing facts violate Florida Administrative Gode 65C-20.001(11)(b) which states: Failure to perform the duties of a mandatory reporter pursuant to Section 39.201, F.S., constitutes a violation of the standards in Sections 402.301-.319, F.S. 8. The violation described above is the second (2™) Class I violation of child care licensing standards. It is the facility's first (1°) Class | violation of Child Care Facility Standards Classifications Summary #63 Failure to Report Suspected Abuse/Neglect within a two-year period. The fine imposed for this violation is Two Hundred Fifty Doliars ($250.00). The facility was also cited with a Class 1 violation for #63 the owner, operator, employee or substitute, while caring for children, committed an act or omission that meets the definition of child abuse or neglect provided in Chapter 39, Florida Statutes. Although no fine was assessed this is the third (3) Class | violation in any standard and therefore the child care license will be suspended for five (5) business days. If you do not wish to contest the findings of this administrative complaint, 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. RIGHT TO ADMINISTRATIVE PROCEEDING IF YOU BELIEVE THE PROPOSED ACTION DESCRIBED IN THIS ADMINISTRATIVE COMPLAINT IS IN ERROR, YOU MAY REQUEST AN ADMINISTRATIVE HEARING IN. ACCORDANCE WITH THE ENCLOSED “NOTIFICATION OF RIGHTS UNDER CHAPTER 120, FLORIDA STATUTES” NOTIFICATION OF RIGHTS UNDER CHAPTER 120, FLORIDA STATUTES IF YOU BELIEVE THE DEPARTMENT'S DECISION IS IN ERROR, YOU MAY REQUEST AN ADMINISTRATIVE HEARING UNDER SECTIONS 120.569 AND 120.57, FLORIDA STATUTES, TO CONTEST THE DECISION. YOUR REQUEST FOR AN ADMINISTRATIVE HEARING MUST BE RECEIVED BY THE DEPARTMENT BY 5:00, P.M., NO LATER THAN 21 CALENDAR DAYS AFTER YOU RECEIVED THE DEPARTMENT’S ADMINISTRATIVE COMPLAINT. You must submit your request for an administrative hearing to the Department at the following address: David Tucker Chief Legal Counsel Department of Children & Families P. O. Box 2417 Jacksonville, FL. 32231-0083 IF YOUR REQUEST FOR AN ADMINISTRATIVE HEARING IS NOT RECEIVED BY THE DEPARTMENT BY THE ABOVE DEADLINE, YOU WILL HAVE WAIVED YOUR RIGHTS TO A HEARING AND THE DEPARTMENT’S PROPOSED ACTION WILL BE FINAL. ANY DENIAL, SUSPENSION, REVOCATION OR OTHER ACTION CONCERNING YOUR LICENSE OR REGISTRATION WILL BE EFFECTIVE ON THAT DATE OR ON ANY LATER EFFECTIVE DATE STATED IN THE ADMINISTRATIVE COMPLAINT, AND ANY PENALTY OR FINE IMPOSED MUST BE PAID WITHIN 30 DAYS THEREAFTER OR ANY EARLIER TIME PROVIDED IN THE ADMINISTRATIVE COMPLAINT. If you disagree with the facts stated in the Department's administrative complaint, you may request a formal administrative hearing under section 120.57(1), Florida Statutes. At a formal hearing, you may present evidence and arguments on all issues involved, and question the witnesses called by the Department. You have the right to be represented by counsel or other qualified representative. If you do not disagree with the facts stated in the Department's administrative complaint, you may request an informal administrative hearing under section 120.57(2), Florida Statutes. At an informal hearing, you may present your argument or a written statement for consideration by the Department. You have the right to be represented by counsel or other qualified representative. Your request for an administrative hearing must meet the requirements of Rule 28- 106.2015(5), Florida Administrative Code, must be prepared legibly on 8% by 11 inch white paper, and include ail of the following items: 4 (a) Your name, address, email address (if any) and telephone number. (b) The name, address, email address (if any) and telephone number of your attorney or qualified representative, if any. (c) A statement requesting an administrative hearing. (d) A statement of all facts in the administrative complaint with which you disagree. If you do not disagree with any of the facts stated in the administrative complaint, you must say so. (e) A statement of when and how you received the administrative complaint. (f) A statement identifying the file number of the administrative compiaint, if shown on the administrative complaint. Section 120.569, Florida Statutes, and rule 28-106.201(4), Florida Administrative Code, require the Department to dismiss your request for hearing if it is not in substantial compliance with the requirements above. Mediation as described in section 120.573, Florida Statutes, is not available. However, other forms of mediation or informal dispute resolution may be available after a timely request for an administrative hearing has been received, 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 or informal dispute resolution 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 3050 0002 0677 3425 to Lutheran Services Florida Inc d/b/a Lutheran Services Florida Inc Rufus E Payne Elementary Head Start, 6725 Hema Ri Jacksonville, FL 32209 this ES Wad day of August 2015. ; Pamela Buckham Safety Progra Manager

Docket for Case No: 15-005053