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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013421388
Report Date: 07/14/2023
Date Signed: 07/14/2023 02:48:12 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
05/31/2023 and conducted by Evaluator Lorraine Dacanay-Breaux
COMPLAINT CONTROL NUMBER: 52-CC-20230531120706
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: 77DATE:
07/14/2023
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Nicole CustinoTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Ratio- Day Care staff are operating out of ratio.
INVESTIGATION FINDINGS:
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On July 14, 2023, Licensing Program Analyst (LPA) Lorraine Dacanay met with Director Nicole Custino for a complaint that was received against the facility for the above allegation. During the visit LPA toured the entire facility for Health and Safety Inspection. Present during LPAs visit were thirteen (13) staff and seventy-seven (77) preschool age children. This facility has a infant license #013421389. During today's visit LPA delivered the findings for this complaint allegation. All staff present have obtained a criminal record clearance. LPA conducted interviews, file reviews and obtained the facility roster.

During the course of the investigation, record review and observation it was found the facility has been out of ratio. LPA determined the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22 is being cited on the attached LIC 9099-D. Failure to submit Proof of Corrections (POC) by Plan of Correction date may result in civil penalties.

A notice of site visit must be posted for 30-days and appeal rights were given. Exit interview conducted and report was reviewed with Nicole Custino.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 52-CC-20230531120706
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: 07/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/28/2023
Section Cited
CCR
101216.3(a)
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(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance...
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Director will send LPA a written statement on how the facility will ensure and continue to remain in compliance regarding ratios during operating hours. Director will provide LPA the detail writing plan via email Lorraine.Dacanay Breaux @dss.ca.gov
by the POC date of
July 28, 2023.
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During the course of the investigation, LPA observed the facility was out of ratio.

This poses a potential risk to the health and safety of the children in care.
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Director will provide LPA the written plan that will ensure the facility will remain in ratio at all times. DIrector will provide staff names and working hours that reflect coverage. Director will email LPA by POC date of 07/28/2023
CCR
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Director will provide LPA the written plan that will ensure the facility will remain in ratio at all times. Director will provide staff names and/working hours that reflects coverage.
Director will email LPA by POC date 07/28/23.
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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: 07/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023
LIC9099 (FAS) - (06/04)
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