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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013421389
Report Date: 04/21/2023
Date Signed: 04/21/2023 02:22:28 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
04/20/2023 and conducted by Evaluator Lorraine Dacanay-Breaux
COMPLAINT CONTROL NUMBER: 52-CC-20230420151615
FACILITY NAME:PRIMROSE SCHOOL OF PLEASANTONFACILITY NUMBER:
013421389
ADMINISTRATOR:NICOLE CUSTINOFACILITY TYPE:
830
ADDRESS:7110 KOLL CENTER PARKWAYTELEPHONE:
(925) 600-7745
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY:35CENSUS: DATE:
04/21/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:TIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Physical Plant -Staff do not ensure changing tables are maintained in good condition
INVESTIGATION FINDINGS:
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On April 21, 2023 Licensing Program Analyst (LPA) L. Dacanay Breaux met today with facility representative, Falguni Buddhdev. During today's visit LPA toured the facility for health and safety. LPA opened a complaint with 6 allegations. The above allegation was visible in the older infant classroom at the diaper changing station and was not in good condition during today's inspection. LPA delivered the findings for the above allegation. LPA observed gnats crawling/flying around the diaper changing area while a child was being changed. During the investigation LPA Dacanay Breaux showed both the Assistant Director and owner the unsanitary diaper station area.

Based on LPAs observation, interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is to be SUBSTANTIATED. As a result, and per California Code of Regulations, Title 22, Division 12, Chapter 1 Section 101438.1(4)(a) and Section 101238 (a)(1) is being cited. Please see LIC 9099-D for deficiency.

A copy of this report is to be given to each child's parent by the next business day and a copy of the LIC 9224 acknowledgement of receipt of licensing reports is to be signed by the parent and put in their child's file. A copy is also to be posted at the facility for 30 days. Any newly enrolled student's parents are to receive a copy of this report for one year.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023
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-20230420151615
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: 013421389
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/21/2023
Section Cited
CCR
101438.1(4)(a)
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101438.1(4)(a) When infants are in care, the diaper-changing area, where residue is splashed, shall be washed and disinfected after each diaper change. (a) The immediate floor and wall areas shall also be kept clean.
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During today's inspection, LPA had the faciltiy clean, disfect and change the diaper station. LPA inspected the area and the area was satisfactory. Facility representative will create and write a plan of prevention ensure the diaper changing stations are sanitary.
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Base on observation of the current condition of the diaper changing area,the facility did not ensure this area was clean, which poses an immediate risk to the health and safety to children in care. This is an potential risk to the Health and Safety or personal rights to persons in care.
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Per owner the entire diaper station will be replaced, the station has been ordered and will take a week to arrive. Facility representive will contact LPA to inspect by 05/08/2023.
Type A
04/21/2023
Section Cited
CCR
101238(a)(1)
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101238(a)(1) Building & Grounds. The child care center shall be clean, safe, sanitary & in good repair at all times to ensure the safety and well-being of children, employees and visitors. (1)The licensee shall take measures to keep the center free of flies, other insects, and rodents.
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During today's inspection, the facility clean and disinfected the diaper changing station.
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Base on observation of the current condition of the diaper changing station this standard was was not met. This is an potential risk to the Health and Safety or personal rights to persons in care.
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Facility representative will create and write a plan of prevention ensure the diaper changing stations are sanitary daily and will submit to LPA by 04/28/2023 via email
Lorraine.Dacanay-Breaux@dss.ca.gov
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: 04/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023
LIC9099 (FAS) - (06/04)
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