STATE OF FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES To: ROARKS FAMILY DAYCARE INC. Certified Mail: 7016 2140 0000 8293 4720 d/b/a Roark’s Family Daycare Inc. Return Receipt Requested 4118 Autrey Ave W Jacksonville, FL 32210 Case# 2019-F04DU0468-1 ADMINISTRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED the Department has imposed a Civil Penalty in the amount of Fifty Dollars ($50.00). 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 ROARKS FAMILY DAYCARE INC. d/b/a Roark’s Family Daycare inc. for violations of child care licensing standards in sections 402.301 — 402.319, Florida Statutes, and chapter 65C-20, Florida Administrative Code. 2. ROARKS FAMILY DAYCARE INC. is licensed under chapter 402, Florida Statutes, and chapter 65C-20, Florida Administrative Code, to operate a family day care home known as Roark’s Family Daycare Inc. License #F04DU0468 located at 4118 Autrey Ave W, Jacksonville, FL 32210. The home’s license is currently a REGULAR License. 3. DCF Licensing Counselor, Scott Arthurs, determined that: The Operator failed to provide the Licensing Counselor with a completed application and renewal packet within the required forty-five (45) days prior to license expiration of September 29, 2019. The application was due in the office by August 15, 2019 and was received on August 15, 2019 however; the renewal fee which is a part of the renewal packet was not received in the Licensing Office until August 16, 2019 this made the application/renewal packet late. The renewal letter states that renewal fee should be included with renewal packet. 1 4. The foregoing facts violate Florida Administrative Code 65C-20.008 (3) which states: A completed CF-FSP Form 5133 for renewal of an annual license must be submitted to the licensing authority at least 45 days prior to the expiration date of the current license to ensure that a lapse of licensure does not occur. Failure to submit a completed CF-FSP Form 5133 at least 45 days prior to the expiration date of the current license constitutes a licensing violation as defined in paragraph 65C- 20.012(3)(d), F.A.C. The department shall issue an administrative complaint imposing a fine of $50.00 for the first occurrence, $100.00 for the second occurrence, and $200.00 for each subsequent occurrence within a five-year period. 5. The violation described above is a violation of child care licensing standards. It is the home’s second (2") violation of a Late Application within a five-year period. The fine imposed for this violation is Fifty Dollars ($50.00). If you do not wish to contest the findings of this administrative complaint, please submit a cashiers cheek of maney ofder made payable to the Florida Department of Children and Families, Child Care Regulation Office, 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 NOTICE OF THE DEPARTMENT’S DECISION. You must 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 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. If you disagree with the facts stated in the Department's decision, 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. If you do not disagree with the facts stated in the notice, 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. Whether you requesting a formal hearing or an informal hearing, your request for an administrative hearing must meet the requirements of Rule 28-106.201(2) or Rule 28- 106.301 (2), Florida Administrative Code. In either event, your request for an administrative hearing must: 1. Include a copy of the decision received from the Department; 2. Be prepared legibly on 8% by 11 inch white paper, and 3. Include all of the following items: (a) The Department's file or identification number, if known; (b) Your name, address, email address (if any) and telephone 3 number and the name, address, email address ( if any) and telephone number of your representative, if any; (c) An explanation of how your rights or interests will be affected by the action described in the notice of the Department's decision; (d) A statement of when and how you received notice of the Department's decision; (e) A statement of all facts in the notice of the Department's decision with which you disagree. If you do not disagree with any of the facts stated in the notice, you must say so; (f) A statement of the facts you believe justify a change in the Department's decision; (g) A statement of the specific rules or statutes you believe require reversal or modification of the Department's proposed action; (h) A statement explaining how the facts you have alleged above relate to the specific rules or statutes you have identified above; and (i) A statement of the relief you want, including precisely the action you want the Department to take. Section 120.569(2)(c), Florida Statutes, requires 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. 7016 2140 0000 8293 4713 to ROARKS FAMILY DAYC, INC. d/b/a Roark’s Family Daycare Inc., 4118 Autrey Ave W, Jacksonville, FL 32210 this day of September 2019. Mala Lill CPM Safety Program Manager Qngete Roarie Roar ks Family a Te Oates ar Bt Boas 25SEP2NS PMZ1 — Sq?) —— JOx-Fi. BBABI~CO8Z 32231-008317 OS ny Ek oe USPS.com® - USPS Tracking® Results Page | of 2 USPS Tracking’ FAQs > Track Another Package + Remove X Tracking Number: 70162140000082934720 Your item was delivered to an individual at the address at 2:38 pm on September 24, 2019 in JACKSONVILLE, FL 32210. Y Delivered September 24, 2019 at 2:38 pm Delivered, Left with Individual JACKSONVILLE, FL 32210 yoeqpee4 Get Updates \v Text & Email Updates Tracking History September 24, 2019, 2:38 pm Delivered, Left with Individual JACKSONVILLE, FL 32210 Your item was delivered to an individual at the address at 2:38 pm on September 24, 2019 in JACKSONVILLE, FL 32210. 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Docket for Case No: 19-005462

Orders for Case No: 19-005462