<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421388
Report Date: 05/12/2023
Date Signed: 05/12/2023 03:22:56 PM

Document Has Been Signed on 05/12/2023 03:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:PRIMROSE SCHOOL OF PLEASANTONFACILITY NUMBER:
013421388
ADMINISTRATOR:NICOLE CUSTINOFACILITY TYPE:
850
ADDRESS:7110 KOLL CENTER PARKWAYTELEPHONE:
(925) 600-7745
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY: 112TOTAL ENROLLED CHILDREN: 112CENSUS: 89DATE:
05/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Nicole CustinoTIME COMPLETED:
04:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On May 12, 2023, at approximately 9:15 AM Licensing Program Analyst (LPA) Lorraine Dacanay Breaux conducted an unannounced complaint inspection and was met by Director Nicole Custino. During the file review there were four (4) staff working and at the facility without a Criminal Record Clearance. Staff present and working without Fingerprint Clearance and was not associated to the facility. LPA took a tour of the facility for a health and safety inspection. Present during the inspection was 89 preschool school and 8 additional staff.

Staff without a fingerprint clearance and association to the facility was S1 (start date was 04/03/23), S2 (start date was 04/3/23), S3(start dated 09/7/22), S4 (start date was 02/13/23) (see 811).

LPA Dacanay Breaux requested and obtain a copy of the facility roster and personnel report. During the course of the investigation LPA reviewed staff files and interviewed center directors. Based on review of all staff personnel files, LPA observed individuals not associated to the facility nor had a valid fingerprint clearance.

Staff working without Fingerprint Clearance. Based on LPA observations, interviews and file review which were conducted, the facility is being cited under California Code of Regulations, Title 22 101170(e)(1) Division 12, Chapter 1, Article 6, are being cited on the attached LIC 809D.

A notice of site visit was given to director and must be posted for 30 days. Appeal Rights provided.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Exit interview conducted and report was reviewed with Director N. Custino.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 05/12/2023 03:22 PM - It Cannot Be Edited


Created By: Lorraine Dacanay-Breaux On 05/12/2023 at 02:49 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: PRIMROSE SCHOOL OF PLEASANTON
FACILITY NUMBER: 013421388

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/12/2023
Section Cited
CCR
101170(e)(1)

1
2
3
4
5
6
7
101170(e)(2) Criminal Record Clearance. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review shall request a transfer of a criminal record clearance from another facility or Trustline.
1
2
3
4
5
6
7
POC - Cleared during visit. LPA sent 4 (four) staff home.
Directors will watch videos on Criminal record clearance and Record Keeping, director will advise LPA of completion.
8
9
10
11
12
13
14
AN IMMEDIATE CIVIL PENALTY OF $500 per staff IS ASSESSED TODAY BECAUSE STAFF MEMBERS S1, S2, S3, S4 CRIMINAL RECORD CLEARANCE IS NOT COMPLETE and NOT ASSOCIATED TO THIS FACILITY.
AN LIC 421BG WAS GIVEN TO DIRECTOR.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Chandra Charles
LICENSING EVALUATOR NAME:Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2