<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421389
Report Date: 11/03/2023
Date Signed: 11/03/2023 11:43:01 AM

Document Has Been Signed on 11/03/2023 11:43 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:
11:20 AM
MET WITH:Nicole Custino TIME COMPLETED:
11:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On November 3, 2023 Licensing Program Analyst (LPA) Lorraine Dacanay Breaux and Brittany Crass conducted a Case Management visit-Unusual incident Report and met with Director, Nicole Custino. Present today were 23 children in care and seven (7) additional staff. The purpose of today's visit is to follow up to an unusual incident report submitted by the facility on 10/6/2023

Per the LIC624 received "....Two teachers got into an altercation in the infant classroom..." Police were called and came to the site no arrest and/or report filed.

Per director the parents in the classroom were notified the date of the incident. Per director there were six children in care on 10/6/23.

LPAs also interviewed director (see 812)

Notice of site visit was given and must remain posted for 30 days. Appeal Rights provided. Report read and appeal rights given to 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)
Page: 1 of 1