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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013421388
Report Date: 09/06/2023
Date Signed: 09/06/2023 04:26:08 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
09/01/2023 and conducted by Evaluator Lorraine Dacanay-Breaux
COMPLAINT CONTROL NUMBER: 52-CC-20230901094621
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: 68DATE:
09/06/2023
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Nicole Custino TIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Neglect/Lack of Supervision - Child left the classroom unattended
INVESTIGATION FINDINGS:
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On 09/6/23, Licensing Program Analyst (LPA) Lorraine Dacanay Breaux arrived unannounced to open a complaint investigation and met with director Nicole Custino. Present were 68 children in care and 13 additional staff members. This facility has a infant component #013421389.

LPA toured the facility with the director for health and safety. All staff present were checked and associated to the facility. LPA requested and obtained a copy of the children's roster and LIC500. LPA completed interviews (see 812).

Based on LPA’s interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation of staff's lack of supervision resulted in child "left the classroom unattended" is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division12, Chapter 1, Section 101229(a)(1), is being cited as a Type A Violation (attached LIC 9099D) LPA provided LIC9224 to give to current families by 9/8/23 and all new families for 12 months, effective 09/06/23. This report must remain on file for three years.

A notice of site visit was given and must remain 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 findings delivered and report was reviewed with the director, Nicole Custino.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
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 4
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
09/01/2023 and conducted by Evaluator Lorraine Dacanay-Breaux
COMPLAINT CONTROL NUMBER: 52-CC-20230901094621

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: 68DATE:
09/06/2023
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Nicole Custino TIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Reporting Requirements- facility did not report incident to parent and/or licensing.
INVESTIGATION FINDINGS:
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On September 6, 2023, Licensing Program Analyst (LPA) Lorraine Dacanay Breaux arrived unannounced to open a complaint investigation and met with director Nicole Custino. Present were 68 children in care and 13 additional staff members. This facility has a infant component #013421389.

LPA toured the facility with the director and visited every classroom to check children and staffing counts. All staff present were checked and associated to the facility. LPA requested and obtained a copy of the children's roster and LIC500. LPA conducted interviews with director.

Based on LPA’s interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation of "facility did not report incident to parent and/or licensing" is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division12, Chapter 1, Section 101212(d), is being cited as a Type B Violation (attached LIC 9099D). This report will stay on file for 3 years.

A notice of site visit was given and must remain 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 the director, Nicole Custino.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
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 4
Control Number 52-CC-20230901094621
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: 09/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/06/2023
Section Cited
CCR
101212(d)
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101212 (d) Reporting Requirements -Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be ...seven days following the occurrence of such event.
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POC Effective immediately director will report via telephone to the DSS within the required 24 hours and written with 7 days. Director will write a statement that she understands and will forward to LPA by 09/8/23.
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This requirement was not met as evidenced by: Director did not contact DSS via telephone to report incident that occured. This poses a potential safety & health risk to children in care.
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Director will email LPA with her written statement by Sept 8, 2023.
Lorraine. Dacanay-Breaux@dss.ca.gov
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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: 09/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 52-CC-20230901094621
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: 09/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/25/2023
Section Cited
CCR
101229(a)(1)
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Title 22, Division 12, Chapter 1, Section 101229(a)(1) No child(ren) shall be left without the supervision of a teacher at any time. Supervision shall include visual supervision.

This regulation is not met as evidenced by:
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POC: Per Director 3 (three) staff was giving a written warning & 09/01/23, DSS provided a training TSP on Care & Supervision. POC by 09/25/23, a written plan of action will be submitted to Licensing detailing the steps staff will take to ensure visual supervision at all time.
THIS IS A ZERO TOLERANCE VIOLATION AND A $500 CIVIL PENALTY IS ASSESSED TODAY AND $100 PER DAY WILL BE ASSESSED UNTIL CORRECTED.
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The facility did not ensure proper supervision resulting in a child leaving the classroom unattend which poses a potential health, safety, or personal rights risk to children in care.
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Director will provided additional training signed by all staff, licensee will email this written statement to LPA Dacanay Breaux at Lorraine.Dacanay-Breaux@dss.ca.gov no later than the due date of 09/25/23.
Since this is a repeated violation LPA will discuss with LPM in regards to additional POC next steps.
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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: 09/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4