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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421389
Report Date: 08/07/2024
Date Signed: 08/07/2024 02:40:15 PM

Document Has Been Signed on 08/07/2024 02:40 PM - 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/
DIRECTOR:		NICOLE CUSTINOFACILITY TYPE:
830
ADDRESS:7110 KOLL CENTER PARKWAYTELEPHONE:
(925) 600-7745
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY: 35TOTAL ENROLLED CHILDREN: 35CENSUS: 23DATE:
08/07/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:54 PM
MET WITH:Jenny Pai TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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 August 07, 2024, License Program Analysts (LPAs) Lorraine Dacanay Breaux visited for an unannounced Case management - Required/Continual Required visits/inspection. This required visit is due to a non-compliance meeting held on June 23, 2023, facility is on required visit for one year. Present for today's visit was assistant director, Jenny Pai and 11 additional staff members (includes administrative staff). There were 23 infant children in care. LPA toured the three (3) infant classrooms. 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 asked facility representatives if there were any new hires, facility representative confirmed two new hires since the last visit.

At 1:45 PM, LPA Dacanay Breaux reviewed three (3) staff files and three (3) children files (infant).

There are is deficiency cited today (see 809-D) Type B.



A notice of site visit was given and must remain posted for 30 days. Appeal rights Provided. Exit interview conducted and report was reviewed with the facility representative, Jenny Pai.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2024
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 2
Document Has Been Signed on 08/07/2024 02:40 PM - It Cannot Be Edited


Created By: Lorraine Dacanay-Breaux On 08/07/2024 at 02:15 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: PRIMROSE SCHOOL OF PLEASANTON
FACILITY NUMBER: 013421389

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/14/2024
Section Cited
CCR
101439.1(f)

1
2
3
4
5
6
7
101439.1 Infant Care Center Sleeping Equipment (f) Cribs shall be free from all loose articles and objects, including blankets and pillows.
1
2
3
4
5
6
7
08/07/24 staff removed the small blanket from the child's crib, infant was asleep.
POC was cleared immediately staff removed.
8
9
10
11
12
13
14
LPA Breaux noticed during the health and safety tour, that a blanket was in an infant's crib while sleep. Which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
Assist. Director will have all staff in that classroom watch and review the Safe Sleep video and information provided to the asst. director on safe sleep. Staff will write a statement of understanding and email to LPA Breaux by 08/14/2024
Email:
Lorraine.Dacanay-Breaux@dss.ca.gov

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Chandra Charles
LICENSING EVALUATOR NAME:Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2