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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421389
Report Date: 11/03/2023
Date Signed: 11/03/2023 11:16:28 AM

Document Has Been Signed on 11/03/2023 11:16 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:
013421389
ADMINISTRATOR:NICOLE CUSTINOFACILITY TYPE:
830
ADDRESS:7110 KOLL CENTER PARKWAYTELEPHONE:
(925) 600-7745
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY: 35TOTAL ENROLLED CHILDREN: 35CENSUS: 23DATE:
11/03/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Nicole CustinoTIME COMPLETED:
11:20 AM
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On November 3, 2023 License Program Analysts (LPAs) Lorraine Dacanay Breaux and Brittany Crass visited for an unannounced Case management - Required/Continual Required visits/inspection. This visit is due to a non compliance meeting, facility is on required visit for one year. Present for today's visit was Director, Nicole Custino and 7 additional staff members. There were 23 infants children in care. LPA reviewed and obtained a copy of the facility roster. A tour of the facility was completed for heath and safety. Hours of operation is Monday - Friday from 7:00 AM - 6:00 PM. This facility has a preschool component facility #013421388.

LPA reminded facility representative that the facility is on required visits for one year and continual required visits. LPA requested and reviewed new hire staff files (3 files) were reviewed for new hire. LPA qualified teachers for infant component.

A notice of site visit was provided and must remain posted for 30 days. Appeal Rights provided. Exit interview conduct with director, Nicole Custino.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2023
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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