State of Florida Department of Business and Professional Regulation Division of Hotels and Restaurants DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, Petitioner, vs. Case Number: 2016026908 KISHON CLAYBORNE License Number: — d/b/a GOLDEN KRUST, mae ine Lag ae 0 Respondent. ile Number: 57123 / Administrative Complaint The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, (“Petitioner”), files this Administrative Complaint against KISHON CLAYBORNE d/b/a GOLDEN KRUST, (“Respondent”), and says: 1. Petitioner is the state agency charged with regulating the operation of public lodging establishments and public food service establishments, pursuant to Section 20.165 and Chapter 509, Florida Statutes. 2. Respondent is, and has been at all times material hereto, licensed by or subject to the jurisdiction of the Division of Hotels and Restaurants. The respondent's business address of record is 620 N UNIVERSITY DR, PEMBROKE PINES, FLORIDA 33024.The mailing address of record is KISHON CLAYBORNE d/b/a GOLDEN KRUST at 620 N UNIVERSITY DRIVE, PEMBROKE PINES, FLORIDA 33024. 3. Inspection of this establishment conducted pursuant to Sec. 509.032, Florida Statutes, revealed violations of the provisions of Chapter 509, Florida Statutes, and / or the rules promulgated thereto governing operation of the establishment. The violation(s) found and applicable law are described in Exhibit “A,” attached hereto and incorporated herein by reference. Inspection documents are attached as Exhibit "B’, incorporated herein by reference. WHEREFORE, Petitioner respectfully requests entry of an Order imposing one or more of the following penalties: administrative fine not to exceed $1,000 per offense, suspension, revocation, or refusal of a license issued pursuant to this Chapter, and/or any other relief authori b orida Statutes, or the rules promulgated thereto. Signed June 07, 2016 wart Shapiro, Di: 3 By delegation of the Director, or designee Division of Hotels & Restaurants Department of Business & Professional Regulation COUNSEL FOR THE DEPARTMENT: Marc Drexler, Lead Attorney Florida Bar No. 0487058 Department of Business & Professional Regulation — - 1940 North Monroe Street Certified Article Number Tallahassee, Florida 32399-2202 quiy 72bb 9904 2040 S052 OS Certificate of Service | = @10]=1B) BY CERTIFIED U.S. MAIL, ARTICLE NUMBER: SENDERS | HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has been hand served by me on this. day of , 2016. Received by: Inspector's Signature Operator's Signature Title Title Case Number: 2016026908 File Number: 257123 District Number: 02 License Number: 1623098 2010 Form revised 04.01.16 GOLDEN KRUST Exhibit A License Number: 1623098 License Type: 2010 PERMANENT FOOD SERVICE Case Number: 2016026908 It is alleged that on April 01, 2016, June 01, 2016 Respondent was in violation of Florida Statute 509 (FS); the Rules of the Division of Hotels and Restaurants, Florida Administrative Code (FAC); and/or specific provisions of the Food Code, Recommendations of the United States Public Health Service, Food and Drug Administration, as incorporated by Chapter 61C, FAC in the following particulars. Copy(s) of the report(s) for the above referenced inspection(s) are attached hereto and incorporated by reference as Exhibit B. ** denotes a high priority violation. * denotes an intermediate priority violation. ** 1.03B-02-4 3-501.16 (A)(1) FC | High Priority: (A) Except during preparation, cooking, or cooling, or when time is used as the public health control as specified under Section 3-501.19, and except as specified under Paragraph (B) and in Paragraph (C ) of this section, potentially hazardous food (time/temperature control for safety food) shall be maintained:(1) At 135 degrees Fahrenheit or above, except that roasts cooked to a temperature and for a time specified in Paragraph 3-401.11(B) or reheated as specified in Paragraph 3- 403.11(E) may be held at a temperature of 130 degrees Fahrenheit or above; Observed - From inspection on 2016-04-01: High Priority - Cooked meats or poultry hot held at less than 135 degrees Fahrenheit or above. Hot hold, brown stew 133°, plantains 111°, curry chicken 128°, reheated over 165°. From follow-up inspection on 2016-06-01: Individual portioned ox-tail and curry goat 121° hot hold in 2 door precision warmer. * 2.53B-02-5 509.049(5) FS Intermediate: It shall be the duty of each public food service establishment to provide training in accordance with the described rule to all food service employees of the public food service establishment. The public food service establishment may designate any certified food service manager to perform this function. Food service employees must receive certification within 60 days after employment. Certification pursuant to this section shall remain valid for 3 years. All public food service establishments must provide the division with proof of employee training upon request, including, but not limited to, at the time of any division inspection of the establishment. Proof of training for each food service employee shall include the name of the trained employee, the date of birth of the trained employee, the date the training occurred, and the approved food safety training program used. Observed - From inspection on 2016-04-01: Intermediate - No proof of required state approved employee training provided for employee hired more than 60 days ago. To order approved program food safety material, call DBPR contracted provider: Florida Restaurant & Lodging Association (SafeStaff) 866-372- 7233. Randal, cook, Natasha, clerk. From follow-up inspection on 2016-06-01: Natasha, clerk has no certificate. Case Number: 2016026908 File Number: 257123 District Number: 02 License Number: 1623098 2010 Form revised 04.01.16 GOLDEN KRUST

Docket for Case No: 16-004996