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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334807214
Report Date: 08/04/2022
Date Signed: 08/04/2022 12:01:25 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/20/2022 and conducted by Evaluator Sumayya Habeebulla
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20220620091743
FACILITY NAME:JAN PETERSON CHILD DAY CARE CENTERFACILITY NUMBER:
334807214
ADMINISTRATOR:LINDA BEDNARFACILITY TYPE:
850
ADDRESS:26895 BRODIAEA AVENUETELEPHONE:
(951) 601-9200
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY:92CENSUS: 54DATE:
08/04/2022
UNANNOUNCEDTIME BEGAN:
11:08 AM
MET WITH:Linda BednarTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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- Staff hit child in care
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Sumayya Habeebulla and Licensing Program Manager (LPM) Carlos Martinez arrived at the facility for the purpose of conducting a subsequent complaint visit, which includes concluding the investigation and delivering the investigation findings regarding the compliant investigation initiated on 06/23/2022. A follow up visit was conducted on 07/20/22 and further interviews were also conducted on this date. LPA met with Director Linda Bednar and discussed the above allegation.

On 06/23/2022 and 07/20/22 LPA Habeebulla conducted interviews with a total of 11 staff and 7 children, all of whom are pertinent to this investigation. Along with interviews, the investigation revealed that:
There is an allegation that a staff hit a child in care. Based on the information obtained through interviews and observations LPA was unable to determine if the allegation occurred or not. Interviews conducted and video surveillance of the classroom that was viewed did not reveal any eyewitnesses to the incident of a child being hit in care.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 10-CC-20220620091743
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 CENTER
FACILITY NUMBER: 334807214
VISIT DATE: 08/04/2022
NARRATIVE
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From the information received by interviews with staff, children, and the video surveillance the above allegation cannot be verified. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted, 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: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/20/2022 and conducted by Evaluator Sumayya Habeebulla
COMPLAINT CONTROL NUMBER: 10-CC-20220620091743

FACILITY NAME:JAN PETERSON CHILD DAY CARE CENTERFACILITY NUMBER:
334807214
ADMINISTRATOR:LINDA BEDNARFACILITY TYPE:
850
ADDRESS:26895 BRODIAEA AVENUETELEPHONE:
(951) 601-9200
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY:92CENSUS: 54DATE:
08/04/2022
UNANNOUNCEDTIME BEGAN:
11:08 AM
MET WITH:Linda BednarTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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- Staff speak inappropriately to children in care
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Sumayya Habeebulla and Licensing Program Manager (LPM) Carlos Martinez arrived at the facility for the purpose of conducting a subsequent complaint visit, which includes concluding the investigation and delivering the investigation findings regarding the compliant investigation initiated on 06/20/2022. A follow up visit was conducted on 07/20/22 and further interviews were also conducted on this date. LPA met with Director Linda Bednar and discussed the above allegations.

On 06/23/2022 and 07/20/22 LPA Habeebulla conducted interviews with a total of 11 staff and 6 children, all of whom are pertinent to this investigation. Along with interviews, the investigation revealed that:




Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 10-CC-20220620091743
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 CENTER
FACILITY NUMBER: 334807214
VISIT DATE: 08/04/2022
NARRATIVE
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There is an allegation that a staff speaks inappropriately to the children in care. During investigation LPA obtained information from interviews conducted that the teacher (S11) in Room 5 (puffer Fish), who has been terminated from the facility as of 07/19/22, speaks to the children in care in an aggressive manner. Interviews and documentation of the incident revealed the following – teacher speaks inappropriately to the children in care and the tone used by S11 is not her normal tone of voice and S11 has also been witnessed using inappropriate language in the presence of children.
Based on the information obtained through interviews and documentation it has been determined that the S11 has been violating Personal Rights of children in care and the above allegation of Personal Rights has been Substantiated at this time.

See LIC 809D for deficiencies.

Appeal rights were discussed and provided during the exit interview.

An Exit Interview was conducted, A Notice of Site visit was given, and the Licensee understands that it must remain posted for 30 days


SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 10-CC-20220620091743
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 CENTER
FACILITY NUMBER: 334807214
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/25/2022
Section Cited
CCR
101223(a)(3)
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(a) The licensee shall ensure that each child is accorded the following personal rights:
(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion,...... threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
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The Director agrees to submit by the POC due date a written statement stating that she will conduct frequent observation of the interactions with staff and children conduct a training on Personal Rights of Children to all staff members currently employed at the facility.
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Based on interviews, the facility did not comply with the section cited above. Staff S11 in Room 5 (Puffer Fish) has been witnessed in using inappropriate language when communicating with children in care which poses an immediate personal rights risk to children in care
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The statement will also include the names and signatures of all staff who attended the training.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5