Findings Of Fact Justification for Agency Action On August 14, 1992, the Manatee County Sheriff's office reported to HRS that a 911 emergency telephone call had been made reporting that an infant died apparently as a result of an accidental choking while at the day care facility owned and operated by the Petitioner, Alice P. White, d/b/a Miss Patty's Day Care Center. On or about August 17, 1992, an autopsy report on the infant found that the cause of death was sudden infant death syndrome (SIDS), which was inconsistent with an accidental choking, and an HRS child day care facility licensing inspector placed a followup call to the Petitioner. Among other things, staffing at the facility on August 14, 1992, was discussed, and the Petitioner assured the inspector that staffing was adequate. They then discussed the incident itself. The Petitioner reported that the infant choked while the Petitioner was sitting in a rocking chair, holding the infant in her arms and feeding the infant. On August 19, 1992, the HRS inspector was instructed to return to the Petitioner's facility for documentation of proper staffing on August 14, 1992. When the HRS inspector arrived, the Petitioner was being interviewed by Manatee County Sheriff's office personnel. While the law enforcement interview was going on, the HRS inspector was able to observe that 18 preschool children were unattended in the bedroom of the Petitioner's son, an unlocked room that officially was not part of the facility. She also was unable to obtain any documentation that the facility was properly staffed on August 14, 1992. The HRS inspector prepared a Child Day Care Inspection Checklist for August 19, 1992, reporting that 18 children were not under direct supervision and that there were 36 children at the facility, six more than the maximum capacity for which the Petitioner's facility was licensed. On August 20, 1992, the HRS inspector returned to the facility because the Sheriff's office had referred the matter to HRS and HRS investigators were at the facility conducting interviews of the facility's staff. One member of the staff informed the HRS personnel that, on the day the infant died, the infant had been left in one of the rooms at the facility without direct supervision at least one time for approximately 30 minutes. When the Petitioner was confronted with the staff member's statement, the Petitioner confessed that she had made, and had been repeating, a false report as to what had occurred on August 14, 1992. In fact, the infant did not die of an accidental choking while the Petitioner was holding the infant in her arms. Rather, the infant was in one of the rooms at the facility without direct supervision; when the Petitioner entered the room and discovered that the infant was not breathing, she called 911 and tried to rescusitate the infant. She stated that she had made, and had been repeating, the false report on the incident in order to personally assume responsibility and to protect her staff from being made responsible. During a prior routine inspection on July 29, 1992, HRS cited the Petitioner for several violations, including insufficient staff ratio, in violation of F.A.C. Rule 10M-12.002(5)(a)(1), and failure to directly supervise, in violation of F.A.C. Rule 10M-12.002(5)(a)(2). On a reinspection on August 12, 1992, the deficiencies cited on July 29, 1992, were corrected; but, in light of the facts HRS learned on August 20, 1992, it appeared that two days later, on the day the infant died, the Petitioner was out of compliance again. In addition, similar violations were observed during inspections on January 13, 1992, and on April 12, 1989. Like all of the other minor violations observed during inspections of the Petitioner's facility over the years, the staff ratio and direct supervision violations were corrected by the time of the following inspection. In response to the inspection report for August 19, 1992, the Petitioner prepared a list of the facility's weak points and steps initiated to correct them. The Petitioner also voluntarily closed her day care center pending the completion of the HRS investigations. Underlying Administrative Proceedings On September 15, 1992, HRS filed an Emergency Final Order suspending the Petitioner's license. On September 21, 1992, HRS filed an Administrative Complaint. The Petitioner requested formal administrative proceedings on the Administrative Complaint, and it was referred to the Division of Administrative Hearings (DOAH), where it was given DOAH Case No. 92-7148. Both the Emergency Final Order and the Administrative Complaint alleged the death of the infant and the false initial report and alleged that the infant actually was left alone without supervision for 30 minutes. Both also alleged that, during HRS' investigation of the incident on August 19, 1992, the following "items of noncompliance" were discovered: The center had 18 school aged children in part of the facility with no staff or direct supervision. This is a violation of Rule 10M-12.002(5)(a)2, F. A. C. The total number of children in the facility was 36, which exceeded the maximum licensed capacity of 30 for the facility. This is a violation of Rule 10M-12.001(2)(j), F. A. C. The staff-to-child ratio was not correct. This is a violation of Rule 10M-12.002(5)(a)1, F. A. C. Both also alleged all of the prior violations found during the inspection history for the facility. On or about October 24, 1992, based on the same information on which the Administrative Complaint was based, HRS gave notice of intent to deny the application which the Petitioner had filed for renewal of her child day care facility license. The Petitioner requested formal administrative proceedings on the intended denial, and it was referred to DOAH, where it was given DOAH Case No. 92-7447, assigned to the same hearing officer as Case No. 92-7148, and consolidated for further proceedings and for final hearing. Final hearing was held on May 12, 1993. The Recommended Order entered in Case Nos. 92-7148 and 92-7447 on May 28, 1993, found the Petitioner not guilty on all charges in the Administrative Complaint and recommended that her license be renewed "forthwith." Among other things, the Recommended Order found: The only charges in the Administrative Complaint regarding this incident [i.e., the death of the infant] is [sic] contained in paragraphs 5 and 8 of the Administrative Complaint. Paragraph 5 alleges the baby died and paragraph 8 alleges that Respondent had provided the sheriff's department with misinformation regarding the infant choking while she was feeding him and that this infant had been left alone for 30 minutes without supervision before being noticed by Respondent. No credible evidence to support the lack of adequate supervision of this infant before its death was presented. The discrepancies found during the quarterly inspections of the facility for the past 3 1/2 years were predominantly minor offenses such as inadequate record keeping, failure to document all staff had received prescribed training or innoculations, lack of current vehicle driver certificate, unsafe outdoor equipment, or minor food service violations, failure to provide employee background screening, inadequate staff to child ratio, inadequate bathroom supplies, and lack of immunization records. These are all classified as Class III violations as defined in Rule 10M-12.011(7)(c), Florida Administrative Code. * * * During the investigation at this day care center following the infant's death, and while the sheriff's deputies were on the scene questioning Respondent and her employees, three additional violations are noted in paragraph 7 of the Administrative Complaint. The first of these allege the center had 18 children in part of the facility with no staff present in the room. At the time this infraction occurred Respondent was out on the patio being interrogated by a deputy and another deputy had called the aide supervising the 18 children out of the room to question her. When Respondent returned inside the center and observed the aide being questioned by the deputy she sent another aide into the room with the 18 school age children. The second allegation was that there were 36 children in the facility although the center was licensed for only 30. Without attempting to justify the violation Respondent testified that this occurred a day or two before school started when the teachers had to be at school but the pupils did not. These excess children were children of teachers who requested Respondent to take them during the time these teachers had to be at school. As a favor to these mothers who had previously used her day care center Respondent temporarily exceeded her authorized number of children. The third violation resulted when Respondent left the children she was supervising to open the door to admit the HRS inspector who supervised the facility. While Respondent was opening the door to let the inspector into the facility the proper ratio of staff to child was not maintained. In response to the inspection reporting the lack of supervision of the 18 school age and excess children in the facility (Exhibit 20) Respondent prepared a list of the facility's weak points and steps initiated to correct them (Exhibit 23). law: On August 28, 1992 Respondent voluntarily closed her day care center pending the completion of all investigations (Exhibit 24). Among other things, the Recommended Order concluded, as a matter of Neither paragraph 5 nor 8 of the Administrative Complaint alleges a violation of either Section 402.310, Florida Statutes or Rule 10M-12.011, Florida Administrative Code which list the grounds for disciplinary action. Since all of the violations charged in the Administrative Complaint were corrected within the prescribed time frame, none of these violations constitute grounds for levying an administrative fine. (Class II violations, if timely corrected, are also not subject to the assessment of a fine) A fortiori, they do not constitute grounds for revocation or refusal to renew a license. Obviously the death of an infant at Respondent's facility on August 14, 1992 led to the decision to deny renewal of the license and the filing of the Administrative Complaint to revoke the license. However, there is no evidence linking any act of Respondent with the death of this infant. There is no dispute that the infant died of SIDS. The infant stopped breathing and had the aide been in the room at the time the infant stopped breathing it is unlikely this would have been noticed had the aide not been looking closely at the child. * * * 24. Even if the minor violations charged in the Administrative Complaint could now be considered to be grounds for revocation, Section 402.310(1)(b), Florida Statutes provides: In determining the appropriate disciplinary action to be taken for a violation as provided in paragraph (a), the following factors shall be considered: The severity of the violation, including the probability that death or serious harm to the health or safety of any person will result or has resulted, the severity of the actual or potential harm, and the extent to which the provisions of this part have been violated. Actions taken by the licensee to correct the violations or to remedy complaints. Any previous violations of the licensee. All of the violations charged in the Administrative Complaint are minor and were corrected forthwith. Respondent submitted a proposed plan to inhibit further violations by increasing staff and preparing written orders for staff guidance. As noted above this is the first Administrative Complaint ever filed against Respondent. From the foregoing it is concluded that there are no violations listed in the Administrative Complaint which were not timely corrected; that once timely corrected these alleged violations do not constitute grounds for further disciplinary actions; and Petitioner has failed to prove, by clear and convincing evidence, or even by a preponderance of the evidence, that Respondent committed any act which constituted grounds for revocation of her license. Over objection, the HRS Secretary allowed its personnel involved in the administrative litigation to file exceptions after the procedural deadline for filing exceptions. HRS' Final Order was rendered on November 1, 1993. It granted an exception to the finding in paragraph 8 of the Recommended Order on the ground that paragraph 4(o) of the Administrative Complaint also was a charge "regarding this incident" in that it charged the Petitioner "with filing a false police report." It also granted an exception to the finding in paragraph 9 of the Recommended Order on the ground that "there was insufficient evidence adduced upon which to base a finding of fact that inadequate staff to child ratios or lack of direct supervision constitute minor discrepancies." (It also was held that "it is the department's duty, not the Hearing Officer's, to interpret what is and is not a minor discrepancy.") The Final Order also observed: The AC also does not charge lack of direct supervision of the dead child. Therefore, the decision in this case does not turn on that issue. The Final Order also granted an HRS exception to part of paragraph 22 of the Recommended Order to the extent that it implied that HRS took action only because of the death of the child. The Final Order noted: "Although the child died from SIDS, counsel for the department is correct in pointing out that if the child had been under direct supervision at all times, the child might still be alive." In a footnote, the Final Order added: "If the department had alleged in the AC a specific lack of direct supervision as to the deceased child, and proved it at the hearing, this case might have turned out differently." Finally, the Final Order granted an exception disagreeing "with any general rule that once timely corrected, previous violations no longer constitute grounds for further disciplinary action." The Final Order observed: The violations cited and corrected over the 3.5 year period preceding the AC in this case are not sufficient to support denial or revocation of a license. That is not to say that in a proper case, previously corrected violations cannot support later disciplinary action. Having granted the foregoing exceptions, the Final Order's disposition of the case was: Based upon the foregoing, it is ADJUDGED, that Alice P. White, d/b/a Miss Patty's Day Care Center is not guilty of the charges legally alleged in the Administrative Complaint. The charge of giving false information to the police is not a violation, under these facts, of the child care licensure statute or rule. It is further ADJUDGED that the license to resume operations be issued forthwith . . .. The Final Order was not appealed. On December 16, 1993, the HRS personnel involved in the prosecution of the administrative proceedings moved for clarification of the Final Order and for remand to DOAH. This action was not appropriate, and on December 29, 1993, the Petitioner initiated action to enforce the Final Order by notifying HRS and the Attorney General of the Petitioner's intent to file an enforcement action under Section 120.69, Fla. Stat. (1993), as required by the statute. On January 14, 1994, an Order Clarifying Final Order was rendered, but in substance the order explained why no clarification was necessary and why the Final Order should be implemented. On or about January 24, 1994, HRS issued the Petitioner a "provisional license." Reasonable Attorney Fees The reasonable amount of time and labor required on this case was approximately 93 hours. (This does not include time spent after entry of the HRS Final Order.) HRS' expert questioned the 93 hours as being perhaps excessive, but she also conceded that she would not question the veracity of representations made by counsel for the Petitioner and that she only had a short period of time in which to study and consider the matter. The legal questions involved in the Petitioner's case were not particularly novel. The most novel question occurred after entry of the Final Order, when HRS inappropriately sought clarification of its own Final Order, and this should be taken into consideration in determining the appropriate fee. In addition, representation of the Petitioner was made difficult by her false reports as to the cause of death of the infant and her subsequent admission to the false reports. A fairly high level of skill was required to perform the legal service properly. The extensive general trial practice experience of counsel for the Petitioner enabled him to perform the service well even though he did not have exceptional experience specifically in the area of administrative law. He also was required to advise the Petitioner on related criminal, tort and bankruptcy matters, and his skills enabled him to do so. Not every specialist in administrative law would have been able to do as good a job in those areas. However, his lack of experience in the area of administrative law required him to expend considerable time devoted to researching pertinent law. There was no evidence that counsel's acceptance of the Petitioner's case precluded other employment. To the contrary, the evidence was that counsel is known for accepting notorious cases and that his practice is not adversely affected by this. The customary fee in Manatee County for handling a case like the Petitioner's ranges anywhere from $135 to $200 an hour. Counsel's fee for handling the Petitioner's case was totally contingent on any sums recoverable from HRS under any applicable statute for the award of attorney fees. If no award is recoverable, he would not expect the Petitioner to pay him any fee. The Petitioner was emotionally distraught during counsel's representation. This presented special problems in the representation and required counsel to expend more time than might otherwise be required for a case like the Petitioner's. Otherwise, the Petitioner's case did not impose any unusual time limitations on counsel. There was no amount of money at issue in the Petitioner's case. But at issue was the Petitioner's licensure, which was her means of earning a living. As for the results obtained, counsel's representation was, in the words of his expert, "devastatingly successful." In fact, it is not clear how counsel was able to achieve such a "devastatingly successful" result on the facts and law of the case. The key seems to have been in persuading the hearing officer and, ultimately, HRS that the Administrative Complaint did not allege lack of direct supervision or improper staff ratio on August 14, 1992, and in persuading the hearing officer that the Petitioner's false reports were of no consequence in the licensure proceeding. See Conclusions of Law 35-36, infra. To the extent not already addressed, the evidence was clear that the experience, reputation, and ability of the Petitioner's attorney is very good. The Petitioner's case would have to be classified as "undesirable." The case was notorious in the community. It involved the Petitioner's false reports as to the cause of death of an infant, to which the Petitioner later admitted. In addition, the Petitioner had no money to pay legal fees. If counsel had not taken the case on the generous terms he did, the Petitioner probably have had serious difficulty obtaining legal representation. Before agreeing to represent the Petitioner in her case, counsel had no prior professional relationship with her, and no future financially rewarding professional relationship with the Petitioner can be anticipated. There was no evidence of any awards in previous cases. Based on the foregoing factors, it is found that a reasonable attorney's fee for counsel representation of the Petitioner in her licensure proceedings is $18,600 (93 hours at $200 per hour.)
The Issue The issue for determination in this case is whether Respondent's license to operate a child day care facility should be revoked for violations of Chapter 402, Florida Statutes, and Rule Chapter 10M-12, Florida Administrative Code.
Findings Of Fact Petitioner, DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES, HRS, is the agency of the State of Florida vested with the statutory authority to license and inspect child day care facilities. Respondent ELMER ROGER PILLSBURY holds a provisional license issued by HRS to operate WHITFIELD ACADEMY, a child day care facility located in Manatee County, Florida. Respondent KAREN PILLSBURY is the manager of WHITFIELD ACADEMY, and is responsible for the day-to-day operations of the facility. In addition to managing WHITFIELD ACADEMY, Respondent KAREN PILLSBURY also operates Kinder Kare Day Care, another licensed child day care center in Manatee County, Florida. At all material times, Respondents ELMER ROGER PILLSBURY and KAREN PILLSBURY have been married. WHITFIELD ACADEMY was first licensed by HRS on June 27, 1989. At that time KAREN PILLSBURY was the owner of the facility. On June 1, 1990, ownership of the facility was transferred from KAREN PILLSBURY to ROGER ELMER PILLSBURY. After the transfer of ownership, KAREN PILLSBURY continued as the operator of the facility, and was in control of the management of the facility. WHITFIELD ACADEMY has an authorized licensed capacity of one hundred and thirty five children. During the period relevant to this proceeding the facility has had a daily census ranging from thirty to ninety children, with an average between fifty and sixty children per day. Staffing at the facility has ranged from four to nine employees. Pursuant to statutory authority, HRS routinely conducts quarterly inspections of licensed child day care facilities. HRS also routinely investigates complaints filed against licensed child day care facilities. Beginning in 1989 and continuing through 1995, HRS has cited Respondents for numerous statutory and rule violations including the following charges set forth in the Administrative Complaint: child abuse; failure to comply with staff/child ratios; failure to maintain direct supervision; improper storage of dangerous chemicals; roach infestation; fire code violations; failure to repair shattered glass in a window; corporal punishment; unsanitary bathrooms; failure to designate staff left in charge; nonconstructive discipline; and failure to cooperate with health officials in responding to an outbreak of Hepatitis A. Child Abuse On or about April 25, 1989, Respondent KAREN PILLSBURY, while working at Kinder Kastle Day Care, disciplined an eighteen-month old child for biting other children by "popping" the child on his mouth with her finger. Respondent KAREN PILLSBURY considered this form of discipline appropriate to prevent small children from biting other children. It is accepted practice by some child development professionals that nonexcessive physical contact may be used as a deterrence to prevent children from biting others. HRS has promulgated Rule 10M-12.013(1)(c), Florida Administrative Code, which prohibits any form of physical punishment in a child care facility. As a result of this incident, a complaint was filed with HRS against KAREN PILLSBURY. HRS investigated the complaint and on May 30, 1989, filed an Administrative Complaint against KAREN PILLSBURY d/b/a/ Kinder Kastle Day Care for violations of HRS's child care standards which, as set forth above, prohibit any corporal discipline on a child in a child care facility. As a result of this administrative action, KAREN PILLSBURY was assessed a fine of $100, which was paid on January 16, 1990. In addition to the administrative fine imposed on Kinder Kastle, on September 29, 1989, as a result of this incident, HRS also proposed to confirm a report of child abuse against Respondent KAREN PILLSBURY for using excessive corporal punishment. Respondent did not seek administrative review of HRS's decision to classify the report as confirmed child abuse. Instead, Respondent applied for an exemption to continue working in a child day care facility. Respondent's application for exemption was denied by HRS on November 20, 1989, and Respondent then sought administrative review of HRS's decision to deny her request for exemption filed with DOAH as Case No. 90-007C. During the pendency of the administrative review denying Respondent KAREN PILLSBURY's application for exemption, Respondent continued to have contact with children at her child care facilities. HRS thereafter filed an Emergency Complaint seeking injunctive relief against Respondent in circuit court, (Case No. CA90-912, Fla. 12th Cir.), and on March 26, 1990 an injunction was issued by the court prohibiting Respondent from being present at Kinder Kastle or Whitfield Academy. Prior to hearing scheduled in the administrative case, HRS and Respondent KAREN PILLSBURY, on May 22, 1990, entered into a stipulated settlement, under the terms of which HRS agreed to grant Respondent an exemption to work at child day care facilities, and Respondent agreed to dismiss the administrative action, receive counseling with regard to alternative ways to modify a child's behavior without the use of corporal punishment, and obtain instruction in social behavior modification. Respondent KAREN PILLSBURY has complied with the terms of the stipulated settlement in DOAH Case No. 90-007C. On June 4, 1990, the circuit court injunction against Respondent was set aside, and Respondent resumed her duties at Kinder Kastle and Whitfield Academy. Staff/Child Ratio Violations HRS has promulgated Rule 10M-12.002(5)(a)1., Florida Administrative Code, which establishes ratios for personnel to children in child day care facilities. The ratios are dependent upon the ages of the children at the facility. During inspections of child day care facilities HRS staff observe the number of children being supervised by facility personnel and record the ratios. HRS staff does not personally check the ages of the individual children in a supervised group, but relies on personal observation as well as the representations made by the facility personnel to determine the ages of the children and whether the ratios are appropriate. Since 1989, WHITFIELD ACADEMY has been cited by HRS for staff/child ratio deficiencies on at least twelve occasions. On September 14, 1989, during a routine quarterly inspection at WHITFIELD ACADEMY, an HRS inspector observed there was one staff member for fourteen children between the ages of one year and two and one half years. The HRS staff/child ratio at that time required one staff member for eight children aged one to two years old and one staff member for twelve children aged two to three years old. The inspection report cited WHITFIELD ACADEMY for this deficiency. At the reinspection of the facility on October 2, 1989, the ratio for this group of children remained at one staff member to fourteen children, and had not been corrected. At reinspection on October 16, 1989, the deficiency was corrected. On April 11, 1990, during the investigation of a complaint filed against WHITFIELD ACADEMY, HRS cited the facility for a staff/child ratio deficiency because two staff members were supervising a group of thirty-eight children who appeared to be of varying ages ranging from three to five years old. The inspection report cautioned WHITFIELD ACADEMY with respect to mixing children of different ages in supervised groups. Upon reinspection by HRS staff on April 25, 1990, this deficiency was corrected. As a result of a complaint filed against WHITFIELD ACADEMY, an inspection was also conducted on April 25, 1990, regarding the staff/child ratio for younger children. At that time HRS staff observed twelve children who appeared to be from under one year old to two years old in the care of one staff member. The staff/child ratio required for children under one year old was one staff member to six children, and for children of one year of age was one staff member for eight children. WHITFIELD ACADEMY was cited for this deficiency. Upon reinspection by HRS staff on May 2, 1990, this deficiency was corrected. On July 11, 1990, HRS cited WHITFIELD ACADEMY for a staff/child ratio deficiency for having one staff member supervising fourteen children, some of whom appeared to be under one year old. Upon reinspection on July 25, 1990, this deficiency was corrected. The staff/child ratio deficiencies at WHITFIELD ACADEMY did not reoccur until March 31, 1992. At that time an HRS inspector cited the facility as deficient when the inspector observed one staff member supervising seven children under the age of one year old in the nursery for a short period of time, approximately twenty to thirty minutes. The required staff/child ratio at that time was one staff member to six infants. Upon reinspection on April 14, 1992, this deficiency was corrected. On August 4, 1992, HRS again cited WHITFIELD ACADEMY for a staff/child ratio deficiency for having one staff member supervise seven infants for a short period of time when another staff member was on leave. Upon reinspection on September 10, 1992, this deficiency was corrected. On January 14, 1993, a complaint was filed with HRS against Respondents WHITFIELD ACADEMY and KAREN PILLSBURY for a staff/child ratio deficiency of one staff member for eight infants under one year old. The deficiency lasted for approximately one hour. In addition, the complaint alleged that on one occasion a staff member left children in the toddler area alone to obtain records for a health nurse, and that two children were sleeping out of the sight of a staff member. As a result of this complaint, on March 10, 1993, administrative action was taken against Respondents, and a fine in the amount of $250 was assessed. Respondents paid the fine on April 8, 1993. On April 21, 1993, Respondents submitted a corrective action plan to HRS to address the problems identified in this complaint. On August 18, 1993, HRS cited WHITFIELD ACADEMY for a staff/child ratio deficiency for having one staff member supervise five infants under one year old. At this time the required ratio had changed from one staff member to six infants, to one staff member to four infants. Upon reinspection on September 1, 1993, this deficiency was corrected. On February 9, 1994, HRS cited WHITFIELD ACADEMY for a staff/child ratio deficiency when an inspector observed two toddlers among a group of older children in the playground. This deficiency was immediately corrected. On March 29, 1994, and on April 20, 1994, HRS received complaints that on two separate occasions the staff/child ratios at WHITFIELD ACADEMY were improper because of the mixing of children of different ages. The allegations of the complaints were verified by HRS, and an administrative fine was assessed against WHITFIELD ACADEMY in the amount of $300 on May 12, 1994. The fine was paid on August 18, 1994. On February 23, 1995, HRS initially cited WHITFIELD ACADEMY for a staff/child ratio deficiency; however, on the same date, when the age of the child in question was verified by reviewing the facility's records, this citation was found to be without basis. On March 23, 1995, HRS cited WHITFIELD ACADEMY for a staff/child deficiency for having one staff member for seventeen children ages two and three when the required ratio was one staff member for eleven two year olds and one staff member for fifteen three year olds. Upon reinspection on April 11, 1995, this deficiency was not corrected. Upon another reinspection on April 21, 1995, this deficiency was corrected. WHITFIELD ACADEMY has experienced difficulty in retaining qualified staff. Some instances of noncompliance with staff/child ratios resulted from staff at the facility being ill, taking breaks, and the failure of staff to report for work. Except for the citations issued on September 14, 1989, and March 23, 1995, all instances of staff/child ratio deficiencies at WHITFIELD ACADEMY were corrected in a timely manner. Failure to Provide Direct Supervision On six occasions WHITFIELD ACADEMY has been cited by HRS for failure to comply with departmental rules governing direct supervision of children at a child day acre facility. HRS has promulgated Rule 10M-12.005(5)(a)2., Florida Administrative Code, which requires personnel at a child day care facility to watch and direct the children's activities with close proximity, within the same room or enclosed outdoor play area, and to be present with the children at all times during the day, including during meals, nap time, and snack time. On September 14, 1989, during a routine quarterly inspection, HRS cited WHITFIELD ACADEMY for failure to provide direct supervision because a staff member at the facility was going in and out of her classroom to assist another staff member at snack time. Upon reinspection on October 2, 1989, the HRS inspector observed children left alone at the facility, and determined that this deficiency had not been corrected. Upon a further reinspection on October 6, 1989, the deficiency was corrected. On April 11, 1990, HRS cited WHITFIELD ACADEMY for failure to provide direct supervision because children were being allowed to leave the playground to go inside to use the bathroom unattended by a staff member. This deficiency was corrected at reinspection on April 25, 1990. On August 4, 1992, HRS cited WHITFIELD ACADEMY for failure to provide direct supervision because volunteers at the facility were being allowed to supervise children out of the presence of a trained staff member. At reinspection on September 10, 1992, this deficiency was corrected. As set forth in Paragraph 23, above, the complaint filed on January 23, 1993, against Respondents WHITFIELD ACADEMY and KAREN PILLSBURY alleged, in addition to a staff/child ratio deficiency, a failure by Respondents to provide direct supervision, in that on one occasion a child was left unattended when a staff member retrieved records for a health nurse, and further alleged that during nap time, some children could not be directly observed by facility staff. This complaint was verified by HRS and resulted in an administrative fine of $250, which Respondents paid on April 21, 1993. Respondents also submitted a corrective action plan which addressed these problems. On August 3, 1994, HRS received a complaint that children at WHITFIELD ACADEMY were not being supervised because one staff member was observed sleeping, and another staff member would, on occasion, leave the room. On August 11, 1994, HRS sent WHITFIELD ACADEMY a warning letter concerning the complaint, and by August 29, 1994, Respondents took corrective action, including dismissal of the staff member found sleeping. On December 19, 1994, HRS received a complaint against WHITFIELD ACADEMY alleging that a five month old child, while strapped in an infant chair, was pushed off a table by a one year old child and received a concussion. The complaint alleged that the two staff members present at the time of the incident were not watching the children. This incident occurred because a child had spilled milk, and one staff member was momentarily involved in cleaning up the spilled milk. The infant was not seriously injured. Improper Storage of Dangerous Chemicals Beginning in 1989, HRS has cited WHITFIELD ACADEMY for improper storage of dangerous chemicals on thirteen occasions. In this respect, HRS has promulgated Rule 10M-12.003(1)(d), Florida Administrative Code, which requires that cleaning supplies, flammables, and other potentially poisonous or dangerous supplies be kept out of the reach of children, and in such a manner as to insure the safety of children. The thirteen citations issued by HRS against WHITFIELD ACADEMY for this deficiency largely result from a failure to lock a supply storage room door at the facility. The supply storage room at the facility is located next to the boys' bathroom and contains cleaning supplies, as well as cans of paint. The supplies and paint are stored on shelves beyond the reach of children. On September 14, 1989, during a routine quarterly inspection of WHITFIELD ACADEMY, HRS staff observed the door to the supply storage room unlocked. This deficiency was corrected at reinspection on October 2, 1989. On November 13, 1989 during a routine quarterly inspection of WHITFIELD ACADEMY, HRS staff observed a can of Lysol spray disinfectant on the toilet tank in the toddler bathroom. This deficiency was corrected at reinspection on November 30, 1989. On February 20, 1990, during a routine quarterly inspection of WHITFIELD ACADEMY, HRS staff observed the door to the supply storage room unlocked. This deficiency was corrected at reinspection on March 6, 1990. During the inspection of WHITFIELD ACADEMY conducted on April 11, 1990, as set forth in Paragraph 18, above, the supply storage door was not locked. This deficiency was corrected at reinspection on April 25, 1990. At a routine quarterly inspection of WHITFIELD ACADEMY on July 11, 1990, items used for crafts, such as paint and hair spray, were observed in an unlocked cabinet in the playroom. This deficiency was corrected at reinspection on July 25, 1990. During a routine quarterly inspection of WHITFIELD ACADEMY on October 16, 1990, the door to the supply storage room was unlocked. This deficiency was corrected at reinspection on October 30, 1990. During a routine quarterly inspection of WHITFIELD ACADEMY on January 9, 1991, the door to the supply storage room was unlocked. This deficiency was not corrected at reinspection on January 24, 1991, but was corrected at reinspection on February 7, 1991. On May 31, 1991, during a food service inspection at WHITFIELD ACADEMY, cleaning chemicals were observed stored over a food preparation counter. At reinspection on June 17, 1991, this deficiency was corrected. Except for the January 9, 1991 citation, all storage deficiencies relating to storage of cleaning supplies and other such materials were corrected in a timely manner. Children at WHITFIELD ACADEMY did not have access to cleaning supplies, flammables, or other potentially poisonous or dangerous chemicals. Pest Control Deficiencies On three occasions since 1989, WHITFIELD ACADEMY has been cited for failure to maintain appropriate sanitation due to problems with pest control. On each occasion evidence of roaches was found at the facility. On January 24, 1991, HRS conducted an inspection of WHITFIELD ACADEMY in response to two complaints filed with the department which alleged that evidence of roaches had been observed at the facility, and that the facility did not conduct appropriate fire drills.. During the inspection, live roaches were observed in the kitchen, behind the soda machine, and in cabinets above and beside the sink. This deficiency was classified as a major infestation. At reinspection on February 8, 1991, the deficiency had been corrected. During a routine food inspection at WHITFIELD ACADEMY on May 31, 1991, live roaches were observed in three different areas. This deficiency was classified as a significant infestation. A routine quarterly inspection conducted on June 6, 1991 also showed evidence of live roaches in the nursery and playroom. At reinspection by the food inspector on June 17, 1991, the deficiency had been corrected, and reinspection again by HRS on July 5, 1991, confirmed that the problem was corrected. All deficiencies cited by HRS against WHITFIELD ACADEMY relating to maintaining proper pest control were corrected in a timely manner. Failure to Designate Staff In Charge On two occasions since 1989, HRS cited WHITFIELD ACADEMY for failure to designate a staff member left in charge of the facility contrary to Rule 10M- 12.002(2)(a), Florida Administrative Code, which requires that when the operator of a facility is absent, a person over 21 years of age must be in charge of, and present at the facility at all times. On October 14, 1992, an HRS food service inspector during a routine inspection of WHITFIELD ACADEMY was unable to locate a specific staff member at the facility willing to accept the food service inspection report. At the time of the inspection KAREN PILLSBURY was absent from the facility. The report was eventually accepted and signed for by Connie Jimenez, an employee of the facility at that time, who was more than 21 years of age. On May 10, 1994, during a routine quarterly inspection, HRS cited WHITFIELD ACADEMY for failure to designate a person in charge. The HRS inspector did not observe or review a posted list of employees of the facility to determine if any employee had been designated in charge at that time. This deficiency was corrected at reinspection on May 24, 1994. Respondent KAREN PILLSBURY, the operator of WHITFIELD ACADEMY, posts a list of employees in her office which designates the employee in charge in her absence. Because of the chronic problems encountered during inspections by HRS at WHITFIELD ACADEMY, employees of the facility were reluctant to acknowledge responsibility for the facility and accept HRS inspection reports. Fire Code Violations On January 24, 1991, in response to the complaints described in Paragraph 48, above, a deputy fire marshal with the Southern Manatee Fire & Rescue District, verified that WHITFIELD ACADEMY did not comply with appropriate fire code standards in that the employees were not properly trained in fire drill procedures, the fire drill log was not properly completed, and the fire drill log inaccurately reflected that fire drills had been regularly conducted at the facility. These deficiencies were corrected at reinspection on February 8, 1991. Premises Safety Hazards On October 10, 1990, during a routine quarterly inspection, HRS cited WHITFIELD ACADEMY for failure to maintain outdoor equipment free from hazards. This deficiency was cited because of a shattered window pane glass located on the side of the building next to the playground. At reinspection on October 30, 1990 the deficiency had not been corrected. The deficiency had been corrected by reinspection on November 13, 1990. Respondents replaced the shattered window pane glass with a shatterproof new window which required a special order. The delay in correcting this deficiency was caused by the shipping time for this special order. Unsanitary Conditions On February 23, 1995, during a routine quarterly inspection, HRS cited WHITFIELD ACADEMY for failure to maintain adequate toilet facilities in violation of Rule 10M-12.003(6)(b), Florida Administrative Code, because of a clogged toilet in the boys' bathroom. The toilet was clogged again at reinspection on March 9, 1995. At reinspection on March 23, 1995, this deficiency was corrected. Children at WHITFIELD ACADEMY occasionally placed items in the toilets. Respondents cleaned and unclogged the toilets on a timely basis. The incident described in Paragraph 59, above, resulted from a child. Corporal Punishment On or about August 17, 1994, an abuse report was filed with HRS alleging that an employee of WHITFIELD ACADEMY used corporal punishment in the discipline of her own child who was attending the facility. The report further alleged that the corporal punishment was inflicted on the child with the permission of Respondent KAREN PILLSBURY in violation of Rule 10M-12.013(1)(c), Florida Administrative Code. This incident resulted in a proposed confirmed report of abuse. Respondent KAREN PILLSBURY did not authorize or otherwise permit the infliction of corporal punishment by an employee of WHITFIELD ACADEMY in the discipline the employee's child on or about August 17, 1994. Nonconstructive Discipline During a routine quarterly inspection on April 7, 1995, HRS cited WHITFIELD ACADEMY for subjecting a child to severe, frightening or humiliating discipline in violation of Rule 10M-12.013(1)(b), Florida Administrative Code. At this time an employee was attempting to restrain a child from biting other children, and was overheard by an HRS investigator to say to the child, "Are you crazy, are you out of your mind?" Respondent KAREN PILLSBURY was not present at the facility when this incident occurred. Respondent KAREN PILLSBURY took remedial measures to address this incident with the employee, and upon reinspection on April 21, 1995, this deficiency was corrected. Hepatitis A Outbreak At the end of July of 1992, twenty-one cases of Hepatitis A, a highly infectious disease, were reported in Manatee County, Florida. At least one reported case was related to a child who had formerly been in attendance at WHITFIELD ACADEMY. The Manatee County Public Health Unit determined that in addition to the former attendee at the facility, thirteen of the other twenty- one reported cases had an association with WHITFIELD ACADEMY. There were no confirmed cases of Hepatitis A found in children in attendance at WHITFIELD ACADEMY, nor in any employees of the facility at that time. As a result of the association of reported cases of Hepatitis A with WHITFIELD ACADEMY, Manatee County Public Health officials recommended that preventative measures be taken at the facility, and that attendees and employees of the facility be tested for immunity to the disease, and if not immune receive Immune Globulin injections. Notifications were also sent to the parents of attending children. Arrangements were made with Manatee County Public Health to provide Immune Globulin injections at WHITFIELD ACADEMY. On the day the injections were given, there was insufficient Immune Globulin available to provide immunizations to all attendees, parents, and employees of the facility, including the Respondents and their family, who had requested the injections. Persons unable to obtain injections at the facility were instructed to contact the Manatee County Public Health Unit; however, there were further problems with obtaining sufficient Immune Globulin which resulted in delays in the inoculation of some of those persons requesting the treatment. Respondents and their family members were inoculated with Immune Globulin. As a result of the initial failure of the Respondents to receive Immune Globulin, and other problems relating to the recommendations for preventative measures at the facility, on August 7, 1992, HRS instituted proceedings in circuit court, Case No. CA-92-003149, Fla. 12th Cir, seeking a temporary restraining order against WHITFIELD ACADEMY from operation for at least sixty days. To resolve this action, WHITFIELD ACADEMY agreed to close from August 12, 1992 through August 23, 1992, to complete a terminal cleaning of the facility by August 24, 1992, to continue immunizations for at least six weeks after any reported case of Hepatitis A was associated with the facility, and to implement certain sanitation measures. The agreement was incorporated into an Order entered by the circuit court on August 24, 1992. Respondents complied with the terms of this agreement. Respondents reasonably cooperated with HRS officials in addressing the problems associated with the outbreak of Hepatitis A in July of 1992. Subsequent to August 24, 1992, there were no confirmed reports of cases of Hepatitis A associated with WHITFIELD ACADEMY. Other Violations On October 30, 1990, an employee of WHITFIELD ACADEMY informed HRS inspectors that a reinspection of the facility could not be conducted until Respondent KAREN PILLSBURY returned. After being shown Section 402.311, Florida Statutes, which authorizes HRS inspections, the employee allowed the inspectors to conduct a partial reinspection. Upon Respondent's return, an inspection was completed. This violation has not reoccurred. During a routine inspection on September 11, 1990, HRS cited WHITFIELD ACADEMY for failure to maintain proper medical examination certificates or immunization records in violation of Rule 10M-12.008, Florida Administrative Code. This deficiency was not corrected at reinspection on September 28, 1990; however these records were subsequently brought into compliance. As a result of the continuing problems at WHITFIELD ACADEMY relating to the record-keeping and other deficiencies, two meetings were conducted on April 16, 1991, with HRS representatives and Respondents and their counsel, at which time agreement on a course of action for resolving these problems was reached. Respondents have made a reasonable effort to comply with this agreement.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that: A Final Order be entered finding that the charges against Respondents ELMER ROGER PILLSBURY, KAREN PILLSBURY, and WHITFIELD ACADEMY are insufficient to warrant licensure revocation, and that the Administrative Complaint filed against Respondents be DISMISSED. RECOMMENDED in Tallahassee, Leon County, Florida, this 29th day of November, 1995. RICHARD HIXSON Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 29th day of November, 1995. APPENDIX As to Petitioner's Proposed Findings 1 - 2. Accepted and Incorporated. 3 - 5. Accepted and Incorporated except that Respondent also has complied with the terms of the settlement agreement. 6 - 7. Accepted and Incorporated except that the deficiencies were corrected. 8. Accepted, except that Respondents and their counsel agreed to cooperate with HRS to remedy the problems. 9 - 15. Accepted and Incorporated, except that the cited deficiencies were corrected. 16. Accepted, except that the replacement glass was on special order, and the problem was corrected. 17 - 25. Accepted, except that the deficiencies were corrected. 26. Accepted, except that Respondents reasonably cooperated with health officials and were finally inoculated. 27 - 35. Accepted and Incorporated, except that the deficiencies were corrected. Rejected to the extent that Respondent authorized corporal punishment. Rejected as irrelevant. 38 - 42. Accepted and Incorporated, except that the deficiencies were corrected. COPIES FURNISHED: Raymond R. Deckert, Esquire DHRS, District 6 Legal Office 4000 W. Dr. Martin Luther King Jr. Blvd. Tampa, Florida 33614 Earl W. Baden, Jr., Esquire 1101 Sixth Avenue West Post Office Box 1907 Bradenton, Florida 34206 Robert L. Powell, Agency Clerk DHRS 1323 Winewood Boulevard Tallahassee, Florida 32399-0700
The Issue The issue in this proceeding is whether Respondent committed the violations as alleged in the Administrative Complaint and, if so, what is the appropriate penalty.
Findings Of Fact The Department of Children and Families is the agency charged with the responsibility of licensing child care facilities in the State of Florida. § 402.305, Fla. Stat. Respondent was licensed by the Department to operate a child care facility located in Callahan, Florida. Tausha Howard is the co-owner/director of Agape, and has been since it opened approximately 10 years ago. Tracey Flanders is a family services counselor. As a family services counselor, Ms. Flanders is responsible for inspecting child care facilities and family child care homes. Agape was one of the child care facilities that she inspected. She has been a family services counselor for three years and prior to that was a child protective investigator for DCF. Prior to her employment with DCF, she was a preschool teacher for eight years, which included some supervisory responsibilities and knowledge of compliance with DCF rules. Out of Ratio/Improper Supervision The Administrative Complaint charged Respondent with being out-of-ratio regarding the number of children per staff member in violation of Florida Administrative Code Rule 65C- 22.001(4)(b)2. Specifically, the Administrative Complaint alleges as follows: During a routine inspection conducted on March 6, 2013, DCF licensing counselor Tracey Flanders observed that: There was one (1) staff member supervising seven (7) children between the ages of one (1) and two (2) years old. A ratio of one staff for (6) children is required. This violation is based on Ms. Flanders’ observations during a March 6, 2013 routine inspection of Agape. She did a walk-through of the facility and examined the children’s records. As part of her walkthrough, she went to all of the classrooms. In each classroom, she counted the children and inspected for cleanliness. While in the toddler room, Ms. Flanders observed the children playing on the floor around the teacher. She counted seven children between the ages of one to two years old being supervised by one teacher. There was one two-year-old and six one-year-old children. Ms. Flanders explained at hearing that in mixed age groups, the required ratio of the youngest child applies. For mixed aged groups of children between one and two years of age, the minimum staff to child ratio is one staff member to six children. Agape has a classroom for preschool children, as well as one for the toddler children. Ms. Howard, however, disagrees that there were seven children in the toddler room and insisted that there were only six. She believes there was some kind of “miscommunication or oversight” because the seventh child (W.) had recently “aged out” of the toddler room and had been moved to the preschool class. The toddler class was where W. was assigned prior to his second birthday and reassignment to the preschool class. At the time of the inspection, the preschool children were out on the playground and came in while Ms. Flanders was present. Ms. Howard recalls she was standing in the baby room window. According to Ms. Howard, W. was being redirected from “bothering the blocks” to go rejoin the preschool group who was having story time. Therefore, she contends that the child was not in the toddler room, but was being redirected into the preschool classroom. Ms. Flanders insists that Ms. Howard was not with her when this incident happened, that the children were playing on the floor, and that the two-year-old in question (W.) was not moved from the toddler room to the preschool room when she was there. Accordingly, she cited Respondent for an out-of-ratio violation. Prior to the March 6, 2013 routine inspection, Agape had previous instances of being in violation of the ratio requirements. As a result of prior Administrative Complaints which included ratio violations, DCF and Respondent entered into a settlement agreement in March 2013, in which Respondent acknowledged that there have been five Class II ratio violations within a two-year period. Additionally, Respondent agreed that if future ratio violations occurred, the license “will again be subject to suspension or revocation.” The settlement agreement also stated that Respondent would finish out its then current probationary status through March 11, 2013, at which time Agape would be returned to an annual license. It is assumed that since the instant Administrative Complaint was dated April 11, 2013, that the license is currently on regular license status. Immunization Form Violation The Administrative Complaint charged Respondent with not having required immunization forms for children in its care, in violation of Florida Administrative Code Rule 65C- 22.006(2)(c). Specifically, the Administrative Complaint alleged that during the routine inspection by Ms. Flanders on March 6, 2013, she observed that a current form 680, Florida Certification of Immunization, was missing for two children. This allegation was based upon a file review made by Ms. Flanders which revealed that immunization records for two of the children, H.A. and M.C., had expired. The same violation was cited three previous times within a two-year period. On a reinspection, the center’s immunization records were current. According to Ms. Howard, the child, H.A., was out of the center for a medical reason and was not enrolled in the center at that time. However, his file was still there. Further, she discussed this with Ms. Flanders and afterwards wrote a statement that H.A. was not currently enrolled in the school and placed it in his file. As for child M.C., the child was enrolled but was no longer attending the center until M.C. obtained a current immunization record. Ms. Flanders explained that the child care facility must inform her if a child is enrolled but not attending. In that event, she skips that child’s record during her review. Level 2 Screening Documentation The Administrative Complaint charged Respondent with a violation of Florida Administrative Code Rule 65C-22.006(4)(d) and alleged the following: Documentation of Level 2 screening was missing for one (1) staff member. The Preschool Teacher’s adult son, D.W., was observed in the classroom with children on more than one occasion. Director stated D.W. is at the facility one (1) to two (2) hours a day, every other day. Licensing Counselor previously advised provider D.W. could not be present without passing a Level 2 screening. These charges were based on Ms. Flanders observing the adult son (D.W.) of one of the preschool teachers sitting at the desk in the preschool room with the children present, and the content of a conversation she had with Ms. Howard regarding this issue. There is an exception to the background screening requirement for volunteers who work there less than 10 hours a month. Accordingly, Ms. Flanders spoke to Ms. Howard to determine how often D.W. was at the school. According to Ms. Flanders, Ms. Howard told her that he would come to the daycare and wait before work every other day for an hour or two before walking to Winn-Dixie. Ms. Flanders calculated that every other day would be 15 days a month, for one or two hours each time. Therefore, she determined that he was there more than 10 hours a month. D.W. does not have background screening on file. The Administrative Complaint states that the same violation was previously cited on May 14, 2011, resulting in Technical Assistance, making this the second Class II violation within two years about persons caring for children without background screening. Ms. Howard, however, denies that D.W. was ever in her child care center that frequently. According to Ms. Howard, D.W.’s family temporarily (for about a month to a month and a half) had only one car. During that time, D.W. would come to the center, but was only there a total of 2 hours in a month. “Again, D.W. is not in my center. He’s not ever been in my center every other day. He’s not ever been in my center more than 30 minutes to an hour.” Moreover, Ms. Howard asserts that when D.W. was in her center, he was not with the children but was in a classroom where there were no children. Both Ms. Flanders and Ms. Howard were credible witnesses.
Recommendation Based upon the Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Children and Families enter a final order placing Respondent’s license on probation until the related cases involving Respondent have been heard and final orders entered; and imposing a fine of $100 per day for one day, and $30 per day for eight days, for a total of $340. DONE AND ENTERED this 8th day of May, 2014, in Tallahassee, Leon County, Florida. S BARBARA J. STAROS Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 8th day of May, 2014
The Issue Whether the Department of Health and Rehabilitative Services properly assessed an administrative fine in the amount of $150.00 on Lourdes Guanlao d/b/a Children's Paradise for violations of Sections 402.305(4) and 402.305(12), Florida Statutes, and Rules 10M-12.002(5) and 10M-12.013(1)(c), Florida Administrative Code.
Findings Of Fact The Department issued a Child Day Care Facility license to Lourdes Guanlao to operate a facility known as Children's Paradise on October 9, 1991. From 1991 to 1994 Petitioner conducted routine facility inspections at Children's Paradise. These inspections included a determination whether the facility was operating with appropriate staff-to-child ratios. On April 1, 1992, Sandy Looney, Respondent's Senior Children's and Families' Counselor, conducted an inspection of Children's Paradise. When Ms. Looney arrived at the facility, Jeane Weiss was the only staff member present. There were seven children present in the center. Two children were under the age of one year and two children were between one and two years old. There should have been two staff members at the facility for the grouping of children present. Within ten minutes of Ms. Looney's arrival, Ms. Guanlao, arrived at the facility thereby correcting the staffing violation. Ms. Guanlao signed the inspection checklist. Ms. Looney discussed the staffing violation with Mrs. Guanlao and left a copy of the checklist with her. On July 27, 1993, Ms. Looney conducted an inspection of Children's Paradise. There were two staff members present at the facility, Ms. Weiss and Ms. Tan. There were sixteen children present in the center. Three children were under the age of one year, six children were between one and two years old. Three staff members were required for the grouping of children present. Ms. Weiss signed the inspection checklist. Ms. Looney left the checklist with staff. Before Ms. Looney left the premises, a staff member arrived for work thereby correcting the staffing violation. On August 17, 1994, Ms. Looney conducted a re-licensure inspection of Children's Paradise. There were two staff members present at the center, Ms. Weiss and Ms. Guanlao. There were twenty-one children present in the center. Seven were under the age of two. Three staff members were required if the children were separated in groups and four staff members were required if the children were all together. Ms. Weiss signed the inspection checklist. Mrs. Looney discussed the violation with Mrs. Guanlao who advised there was no substitute or other staff member available to call to work. Correction of the staffing violation was due on August 18, 1994. On August 18, 1994, Ms. Looney returned to Children's Paradise to determine if Ms. Guanlao had corrected the staffing violation. At that time there were eighteen children present. Six children were under the age of two. The same two staff members were present, Ms. Weiss and Ms. Guanlao. Mrs. Guanlao called a ten year old child to assist and again indicated that there was no adult available to call. Each time that Ms. Looney inspected Respondent's facility, she actually counted the number of children present and asked staff to verify their age. Evidence to the contrary is not persuasive. On August 29, 1994, Petitioner issued an Administrative Complaint imposing a fine in the amount of $75.00 for the August 17, 1994, staffing violation which Respondent had not corrected at the time of reinspection on August 18, 1994. This complaint properly advised Respondent of her right to a proceeding pursuant to Section 120.57(1), Florida Statutes. By letter dated September 13, 1994, Ms. Looney advised Ms. Guanlao that if she disputed the imposition of the fine, she could request an administrative hearing. The letter further stated that if Ms. Guanlao did not dispute the fine, she could pay it by mailing a check or money order. Ms. Guanlao tendered check number 1839 dated September 22, 1994, in the amount of $75.00 with "Adm. Fine" noted thereon. Ms. Looney transmitted this check to the fiscal office for deposit on or about October 7, 1995. There is no persuasive evidence that Ms. Looney told Ms. Guanlao she had to pay the administrative fine or risk losing her license. Gerald Stephens, Protective Investigator for Petitioner went to Children's Paradise on November 18, 1994. The purpose of his visit was associated with an investigation unrelated to this proceeding. When Mr. Stephens arrived at the facility, Ms. Guanlao was the only staff member present. He observed ten children in the center. The youngest child present at the center was eighteen months old. This number of children required at least two staff members to be present at the facility. Mr. Stephens interviewed one of Ms. Guanlao's staff members on the morning of November 18, 1994. There is no persuasive evidence that Mr. Stephens prevented the staff member from showing up for work that morning by telling her he was going to shut the facility down. Seven witnesses testified that they were volunteers at the center and had agreed to act as substitute staff on an as needed basis. Only two of these people had been properly screened and trained to work in a day care center or with children. One of these two volunteers did not receive her certification to work in a day care facility until October 3, 1994. Some of the volunteers had other full time jobs. Consequently, the times they were available to help Ms. Guanlao was limited. There is no evidence that Ms. Guanlao called any of these people to substitute on April 1, 1992, July 27, 1993, August 17, 1994, August 18, 1994 or November 18, 1994. Ms. Guanlao attended a training course that Ms. Looney conducted prior to October 9, 1991. One purpose of the course was to familiarize participants with the rules regulating child day care centers. During the training Ms. Looney provided Ms. Guanlao with written material including the Child Care Standards contained in Rule 10M-12, Florida Administrative Code. This rule sets forth staffing requirements and child discipline standards. Ms. Looney and Ms. Guanlao discussed subsequent changes in the rules related to staffing requirements. Ms. Looney also explained to Ms. Guanlao that the staffing requirements applied at all times the children were in the center regardless of the activity that was taking place. In other words, the staff-to- child ratios applied even if the children were napping. On August 19, 1994 Ms. Looney received a complaint involving the day care center on an unrelated licensing issue. As a result of the subsequent investigation, Ms. Looney was at the facility on August 24, 1994. During that visit, Ms. Guanlao admitted that she sometimes slapped the children on the hands as punishment.
Recommendation Based upon the findings of fact and the conclusions of law, it is, RECOMMENDED: That Petitioner Department of Health and Rehabilitative Services enter a Final Order imposing an administrative fine on Respondent Lourdes Guanlao d/b/a Children's Paradise in the amount of $150 for violating Rules 10M-12.002(5) and 10M-12.013(1)(c), Florida Administrative Code. DONE and ENTERED this 16th day of October, 1996, in Tallahassee, Leon County, Florida. SUZANNE F. HOOD Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 SUNCOM 278-9675 Fax Filing (904) 921-6847 Filed with the Clerk of the Division of Administrative Hearings this 16th day of October, 1996. COPIES FURNISHED: Frances S. Childers, Esquire District 3 Legal Office Department of Health and Rehabilitative Services 1000 NE 16th Avenue, Box 3 Gainesville, Florida 32601 Michael M. Naughton, Esquire 3840-4 Williamsburg Park Boulevard Jacksonville, Florida 32257 Gregory D. Venz, Agency Clerk Department of Health and Rehabilitative Services Building 7, Suite 204-X 1317 Winewood Boulevard Tallahassee, Florida 32399-0700 Richard Doran, Esquire Department of Health and Rehabilitative Services 1317 Winewood Boulevard, Room 204 Tallahassee, Florida 32399-0700
The Issue Whether Respondent, a licensed child care facility, committed two Class I violations as alleged in the Administrative Complaint; and, if so, the appropriate penalty, including whether Petitioner may terminate Respondent's participation in the Gold Seal Quality Care program.
Findings Of Fact The Department is the state agency responsible for licensing and regulating child care facilities in the state in Florida. StarChild is a licensed child care facility located in Apopka, Florida. StarChild is designated as a Gold Seal Provider and has a contract with the Early Learning Coalition to provide school readiness services. As a designated Gold Seal Quality Care Provider, StarChild is subject to the provisions of section 402.281, Florida Statutes. In order to obtain and maintain a designation as a Gold Seal Quality Care provider, a child care facility must not have had any Class I violations, as defined by rule, within the two years preceding its application for designation as a Gold Seal Quality Care provider. § 402.281(4)(a), Fla. Stat. "Commission of a Class I violation shall be grounds for termination of the designation as a Gold Seal Quality Care provider until the provider has no Class I violations for a period of two years." § 402.281(4)(a), Fla. Stat. 1 By agreeing to an extended deadline for post-hearing submissions beyond ten days after the filing of the transcript, the parties waived the 30-day timeframe for issuance of the Recommended Order. See Fla. Admin. Code R. 28-106.216. As of the date of the final hearing, StarChild had never had a Class I violation. The May 5, 2020, Incident At all times relevant to this case, CJ was a two-year-old boy who attended StarChild. On May 5, 2020, CJ, along with several other children and two teachers, were in a two-year-old classroom at StarChild. The actions of the children and a teacher, Ms. Crisman, were recorded by a surveillance camera mounted in the room. The factual allegations in the Administrative Complaint are primarily based on an incident captured on video. In the video, CJ is seen interacting with other children in the room. The children are all engaged in different activities; some are standing while others are sitting on the floor. CJ stood near a group of children who were sitting on the floor in close proximity to Ms. Crisman, who also sat on the floor. CJ walked up behind another child who sat in front of Ms. Crisman. CJ placed his hands on the other child's shoulders. The other child turned his torso toward CJ, while still sitting, and pushed CJ away from him. This was by no means a hard push. CJ stumbled into a seated position and then immediately thereafter laid on his back. CJ remained laying on his back for approximately five to ten seconds, during which he playfully kicked his feet. Ms. Crisman stood up from her seated position, walked over to CJ, and stood over him. She then grabbed CJ by both wrists and forcefully yanked him off the ground. It is clear from the video that Ms. Crisman used great force when she pulled CJ off the floor—CJ's feet flew up in the air and his head flew back. Ms. Crisman then pulled CJ, by his wrists, approximately ten feet across the room, and placed him in a corner in timeout. CJ sat in the corner clutching his arm. Zuleika Martinez (Ms. Martinez) was one of the two teachers assigned to CJ's classroom. She was not present during the incident, but came back to see CJ sitting in timeout. Ms. Martinez noticed that CJ was favoring one hand over the other. Approximately 30 minutes after noticing this, Ms. Martinez notified Deborah Files (Ms. Files). Ms. Files has been employed by StarChild since March 2005, and has been serving as the Director of StarChild since April 2020. Ms. Files walked over to the classroom to check on CJ and speak to Ms. Martinez. She learned that CJ was holding his arm and he would not use it for play or to eat. Ms. Files brought CJ into StarChild's front-desk area—the area typically used for children who are not feeling well. Ms. Files iced CJ's arm. Shortly thereafter, Ms. Files contacted Shelby Feinberg (Ms. Feinberg). At the time of the incident, Ms. Feinberg was the Executive Director of StarChild. Ms. Feinberg was working remotely and, therefore, not at StarChild's facility. Ms. Files explained to Ms. Feinberg that CJ appeared to be having difficulty utilizing one of his arms. Ms. Feinberg advised Ms. Files to contact CJ's parents. Ms. Files contacted CJ's mother, Meghan Jones, at approximately 11:00 a.m. Ms. Files reported to the mother that CJ was favoring one arm, and that he was not using the other arm at all. Ms. Files encouraged Ms. Jones to pick CJ up. At approximately 12:30 p.m., CJ's father, Kurt Jones (Mr. Jones), arrived at StarChild to pick CJ up. Mr. Jones found CJ in the classroom, lying on the floor. He told CJ to get up. CJ attempted to push himself up off the floor but was unable to do so. CJ appeared to be in pain and unable to support his body weight on his arm. It was clear to Mr. Jones that his son was in pain. Mr. Jones had difficulty getting CJ strapped into his car seat. Mr. Jones drove CJ to their home, which was five minutes away. When at home, Mr. Jones noticed that CJ still appeared to be in pain. Mr. Jones noticed that CJ would not move or touch his arm. He was holding his arm as if it was in a sling. CJ would periodically cry. Mr. Jones grew worried as his son still appeared to be in pain and did not seem to be getting better as time passed. Mr. Jones considered taking CJ to the emergency room but decided against it because of concerns related to the COVID-19 pandemic. He could not take CJ to his primary care pediatrician as there were scheduling difficulties also tied to the COVID-19 pandemic. The family's usual after-hours urgent care pediatrics office did not open until 4:00 p.m. At approximately three or four hours after picking CJ up from StarChild, Mr. Jones, with few options, searched for help on the internet. He researched possible causes of CJ's pain and why he was holding his arm like a sling. After watching several videos, he came across a YouTube video made by a nurse who described a condition called "nursemaid elbow." A nursemaid elbow is a dislocated elbow. The symptoms matched what CJ was experiencing and Mr. Jones determined CJ had dislocated his elbow. The video provided instructions on how to correct the nursemaid elbow. Desperate to help his son who was still in pain, he attempted the procedure to put CJ's elbow back in place. Mr. Jones followed the instructions. He heard a "pop" noise, which was to be expected per the instructions in the video. CJ cried for ten to 15 seconds. Thereafter, CJ regained full mobility of his arm and no longer appeared to be in pain. CJ began acting like his typical self. The next day, Mr. and Mrs. Jones took CJ to his pediatrician. CJ was diagnosed with nursemaid elbow. They were advised that the procedure that Mr. Jones conducted the previous day was the correct one. The Department conducted an investigation of the incident. As part of its investigation, the Department scheduled an examination of CJ by its Child Protective Team (CPT). Margarita Diaz (Nurse Diaz) is a pediatric nurse practitioner who works for CPT. She has been with CPT for three years. She has received extensive training in child abuse. On May 7, 2020, she did a complete head- to-toe examination of CJ. She reviewed the history of CJ's injury provided by CJ's parents and collateral information which included the video of the incident. She diagnosed CJ as having suffered a nursemaid elbow due to child abuse. Nurse Diaz described a nursemaid elbow as a condition that occurs when the ligament in the elbow gets trapped between two bones. When a child's arm is pulled away, the tendon slips down. When the arm goes back into place, the tendon gets stuck between the humerus and the radial bones. When this condition happens, it is usually very painful for the child. The child often presents as protective of the arm and will not move it. Nurse Diaz further testified that the most common mechanism of injury is when a child is pulled. Other mechanisms for injury include swinging or lifting a child by the arm. She testified that a nursemaid elbow is easy to correct and once corrected, a child is back to normal in five to ten minutes. Nurse Diaz testified that her finding of child abuse was based on her observations of the actions of the teacher as shown in the video. She confirmed that the actions of the teacher in the video were consistent with the infliction of a nursemaid elbow injury on CJ. StarChild's Response to Incident When Ms. Martinez reported CJ's injury, StarChild took immediate action to address the situation. They removed CJ from the classroom, tended to his injuries, promptly contacted his parents, and set out to find out the cause of the injury. StarChild administrators watched video footage of the activity leading up to CJ's change in behavior. In reviewing the video, StarChild determined that Ms. Crisman used improper form by lifting CJ by his wrists when moving CJ to the timeout corner. By noon on the same day of the incident, StarChild terminated Ms. Crisman's employment. StarChild then contacted the Department to report the incident. Mr. Jones made a request to review video footage of the incident. Danny King, the owner of StarChild, reached out to Mr. Jones personally and agreed to meet with him and Mrs. Jones to review the video together in person. The parents were informed that Ms. Crisman was terminated. Following the incident, StarChild developed a self-imposed Corrective Action Plan, that included re-training its entire staff. Ms. Feinberg met with all members of the staff and conducted in-person training in small class settings. All staff members were provided StarChild's discipline policy and child interaction policies. Staff members were also required to take a child abuse and training course. StarChild re-wrote its staff handbook to include stronger and clearer language about how children are to be moved and repositioned in the classroom. Additionally, StarChild implemented permanent policy changes which required discussions during weekly staff meetings about behavior and how staff members should positively deal with behavior in the classroom. All staff members were also provided with information on nursemaid elbow, specifically. StarChild has current plans to bring in guest speakers, such as a behavior management professional and a CPT speaker, to further educate their staff members. StarChild acted commendably in response to the incident. It took immediate and comprehensive action to try to reduce the probability of an incident like that occurring again. It must be noted that complete prevention is an impossibility. CJ continued to attend StarChild after the incident. Indeed, he attended StarChild the day after the incident and appeared to be in good spirits. CJ's younger sister was also enrolled at StarChild after the incident, when she was three-and-a-half months old.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Children and Families impose a fine of $100.00 against StarChild and revoke its designation as a Gold Seal Quality Care provider. DONE AND ENTERED this 19th day of May, 2021, in Tallahassee, Leon County, Florida. COPIES FURNISHED: Brian Christopher Meola, Assistant General Counsel Department of Children and Families Suite S-1129 400 West Robinson Street Orlando, Florida 32801 Lacey Kantor, Agency Clerk Department of Children and Families Building 2, Room 204Z 1317 Winewood Boulevard Tallahassee, Florida 32399-0700 S JODI-ANN V. LIVINGSTONE Administrative Law Judge 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 19th day of May, 2021. Lucia C. Pineiro, Esquire Lucia C. Pineiro & Associates, P.A. Suite 309 717 Ponce de Leon Boulevard Coral Gables, Florida 33134 Javier A. Enriquez, General Counsel Department of Children and Families Building 2, Room 204F 1317 Winewood Boulevard Tallahassee, Florida 32399-0700
The Issue The issues in the case are whether the Respondent violated applicable rules of the Florida Administrative Code, and whether a fine of $150 is warranted for the alleged violations.
Findings Of Fact At all times material to this case, the Respondent was a Florida-licensed Child Care Facility located at 650 West Main Street, Bartow, Florida. On June 3, 2003, an employee representing the Petitioner conducted a routine inspection of the Respondent facility. Upon completion of the inspection, the Respondent received a copy of the inspection report. At the time of the June 3 inspection, some children were moving back and forth without supervision between their assigned areas, which resulted in the facility being out of compliance with staff-to-child ratio requirements set forth in the Florida Administrative Code. Applicable rules require that there be one staff member responsible for every four children between the ages of birth and one-year-old. At the time of the inspection, there were four children in the infant area, plus an additional two children beyond the age of one walking without supervision through the area. The older children were not directed to return to their assigned area by the one facility employee in the infant area. Because there was only one staff person in the infant's area, the facility was out of compliance with the required ratio. Applicable rules require that there be one staff member responsible for every six children between the ages of one and two years old. At the time of the inspection there were six children in the one-year-old area, plus two additional children beyond the age of two who were playing in the area. The older children were not directed to return to their assigned area by the staff member present. Because there was only one staff person in the area, the facility was out of compliance with the required ratio. On December 2, 2003, an employee representing the Petitioner conducted a routine inspection of the Respondent facility. Upon completion of the inspection, the Respondent received a copy of the inspection report. At the time of the December 2 inspection, there were a total of six children in the infant area with one staff person present. Because there was only one staff person in the infant's area, the facility was out of compliance with the required ratio of one staff member responsible for every four children present. The Petitioner regards the failure to comply with staffing ratio requirements as a serious child safety issue. Lack of compliance with required staffing ratios poses the potential for injury or other harm to children who are left without sufficient supervision. By letter dated March 15, 2004, the Petitioner notified the Respondent of the proposed fine and set forth the following as the basis for the penalty: The Department proposes to fine your child care facility for violations of the Florida Administrative Code by authority of section 402.310, Florida Statutes. This letter is considered an administrative complaint for the purposes of section 120.60(5), Florida Statutes. . . . Inspections on June 3, 2003 and December 2, 2003 reflected repeat violations. On June 3, 2003, the infant and one year old groups were both over ratio. On December 2, 2003, during a routine child care inspection of your facility a Department licensing inspector found the infant room to be over ratio. This situation violates the Florida Administrative Code, Rule 65C-22.001(4), which requires a staff-to-children ratio as established in section 402.305(4), F.S. For these violations, the Department proposes to fine your facility the sum of $150.00. The Respondent testified at the hearing. The Respondent asserted that at the time of the inspections, adequate staff were present in the facility, but for various reasons were not in the areas being observed by the inspectors, and that ratio requirements were unmet for minimal periods of time. The Respondent also asserted that at the time of the inspections, there was a lack of barriers in the facility that would prevent children from wandering in and out of the age- related areas. Additional walls have now been constructed to prevent the children from wandering.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Petitioner enter a Final Order imposing a fine of $150 against the Respondent. DONE AND ENTERED this 7th day of July, 2004, in Tallahassee, Leon County, Florida. S WILLIAM F. QUATTLEBAUM Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 7th day of July, 2004. COPIES FURNISHED: Jack Emory Farley, Esquire Department of Children and Family Services 4720 Old Highway 37 Lakeland, Florida 33813-2030 Carla Meeks Ruth Johnson Best Academy 650 West Main Street Bartow, Florida 33830 Paul Flounlacker, Agency Clerk Department of Children and Family Services Building 2, Room 204B 1317 Winewood Boulevard Tallahassee, Florida 32399-0700 Josie Tomayo, General Counsel Department of Children and Family Services Building 2, Room 204 1317 Winewood Boulevard Tallahassee, Florida 32399-0700
