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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013421388
Report Date: 05/24/2023
Date Signed: 05/24/2023 03:20:30 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/26/2023 and conducted by Evaluator Lorraine Dacanay-Breaux
COMPLAINT CONTROL NUMBER: 52-CC-20230426103004
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:112CENSUS: 87DATE:
05/24/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Fulguni BuddhdevTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Qualifications - Unqualified adults(s) care for day care children.
INVESTIGATION FINDINGS:
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On 5/24/2023, at approximately 09:30 AM., Licensing Program Analysts (LPAs) Lorraine Dacanay Breaux and Christina Uribe conducted an unannounced subsequent visit at Primrose School of Pleasanton. LPAs met with Assistant Director, Falguni Buddhdev. During today's visit was twelve (12) additional staff members and eighty-seven (87) preschool children in care. This facility has a dual license (infant component #01342139).

LPAs obtain a facility and personnel roster, reviewed staff files and six (6) staff files were missing. Due to missing documents. LPA was unable to verify if staff was qualified. Therefore this allegation is SUBSTANTIATED. Based on LPAs observation and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is to be substantiated. All staff facility files must be completed by May 31, 2023, failure to comply will result in immedate civil penalties.

A notice of site visit was given to facility representative and must be posted for 30 days. Appeal Rights provided. Exit interview conducted and report was reviewed with Facility Director, F. Buddhdev.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
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 2
Control Number 52-CC-20230426103004
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 PLEASANTON
FACILITY NUMBER: 013421388
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2023
Section Cited
CCR
101217(D)
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101217(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review.
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POC - Director will have all facility files completed with all CCLD Required documentation by May 31, 2023. This is the second request for completed files.
Director will submit a written plan how she will ensure files will be completed and Director will complete Record Keeping Class and submit the certifcation to LPA.
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This requirement was not met as evidenced by: SIx (6) staff files were not available for LPA to review. This poses a potential risk to the health and safety of the children in care.


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LPA will schedule and send Director a letter for a mandatory non compliance meeting.
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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: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
LIC9099 (FAS) - (06/04)
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