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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421388
Report Date: 08/26/2024
Date Signed: 08/26/2024 11:30:57 AM

Document Has Been Signed on 08/26/2024 11:30 AM - 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/
DIRECTOR:		NICOLE CUSTINOFACILITY TYPE:
850
ADDRESS:7110 KOLL CENTER PARKWAYTELEPHONE:
(925) 600-7745
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY: 112TOTAL ENROLLED CHILDREN: 112CENSUS: 62DATE:
08/26/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Nicole CustinoTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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On August 26, 2024, License Program Analyst (LPA) Lorraine Dacanay Breaux met with Director, Nicole Custino for an Unannounced Case Management/Other Visit. LPA Breaux following up from previous visit.

LPA Dacanay Breaux read and reviewed with Director Nicole Custino. Notice of Site provided. Appeal Rights Provided. Exit interview conducted with director, Nicole Custino.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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