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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334807214
Report Date: 05/02/2024
Date Signed: 05/02/2024 09:14:41 AM

Document Has Been Signed on 05/02/2024 09:14 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:JAN PETERSON CHILD DAY CARE CENTERFACILITY NUMBER:
334807214
ADMINISTRATOR/
DIRECTOR:		LINDA BEDNARFACILITY TYPE:
850
ADDRESS:26895 BRODIAEA AVENUETELEPHONE:
(951) 601-9200
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY: 92TOTAL ENROLLED CHILDREN: 92CENSUS: DATE:
05/02/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:55 AM
MET WITH:Linda BednarTIME VISIT/
INSPECTION COMPLETED:
09:30 AM
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Licensing Program Analysts (LPA) Sumayya Habeebulla arrived at the facility for the purpose of delivering LIC421IM and obtain facility Representative’s Signature.


An exit interview was conducted with the Facility Director Ms. Linda Bednar, a Notice of Site Visit posted, and a copy of this report was provided to the facility on this date and time.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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