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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013422060
Report Date: 10/08/2021
Date Signed: 10/08/2021 10:45:56 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/26/2021 and conducted by Evaluator Jaylena Miller
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20210826154325
FACILITY NAME:PRIMROSE SCHOOL OF LIVERMOREFACILITY NUMBER:
013422060
ADMINISTRATOR:GUPTA, SHUBRAFACILITY TYPE:
850
ADDRESS:2901 LAS POSITAS RDTELEPHONE:
(925) 215-7372
CITY:LIVERMORESTATE: CAZIP CODE:
94551
CAPACITY:110CENSUS: 13DATE:
10/08/2021
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Shubra GuptaTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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8
9
staff confrontation in front of children
INVESTIGATION FINDINGS:
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2
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5
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8
9
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11
12
13
On 10/8/2021 at 8:30am Licensing Program Analyst (LPA) Jaylena Miller conducted an unannounced subsequent complaint investigation regarding the above allegation and met with Director Shubra Gupta and explained the purpose of the visit.
During the investigation LPA Miller conducted an interview with Director and Assistant Director. Director and Assistant Director did explain that there was a confrontation between two staff members in the presence of children but was deescalated quickly.

Based on LPA Miller’s interviews which were conducted, and records reviewed, the preponderance of evidence standard has been met, therefor the above allegation is to be SUBSTANTIATED. As a result, and per California Code of Regulations, Title 22 Division 12, Chapter 1, Section 101223(a)(1) is being cited on LIC 9099-D. This report must remain on file for three years. The director was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. Notice of site visit was provided and must be posted for thirty days. Exit interview conducted with director, Shubra Gupta.

Please see LIC 9099-D for deficiency cited
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
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 4
Control Number 52-CC-20210826154325
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: PRIMROSE SCHOOL OF LIVERMORE
FACILITY NUMBER: 013422060
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/08/2021
Section Cited
CCR
101223(a)(1)
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101223(a)(1) Personal Rights
(a)The Licensee shall ensure that each child is accorded the following personal rights: (1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidence by:
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2
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7
Facility will have a staff meeting/training on staff differences and the proper way to resolve them without violating personal rights of children. Staff will also watch the video on Children’s Personal Rights in Child Care. Director will provide LPA a sign in sheet by 11/01/2021.
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Based on interviews, the facility did not ensure dignity in the children(s) personal relationships with staff when the facility failed to prevent a confrontation between staff in the presence of children which poses a potential risk to the health and safety to children in care.
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Failure to correct will result in a $100.00 per day civil penalty until corrected. Repeat violations are $250.00 per violation and $100.00 per day until corrected.
Type B
10/08/2021
Section Cited
CCR
101212(d)
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Reporting Requirements 101212(d)
Upon the occurrence, during the operation of the childcare center of any of the events specified in (d)(1) a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report … Department within seven days following the occurrence of such event. This requirement was not met as evidence by:
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Director will submit an unusual incident report to Community Care Licensing by November 7th, 2021. Director will view the video for Child Care Reporting Requirements and submit a summary by November 7th, 2021.
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Based on interviews, the facility failed to report a positive COVID case at the facility on 8/12/2021,8/14/2021,8/17/2021,8/25/2021, which poses a potential risk to the health and safety to children in care
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Failure to correct will result in a $100.00 per day civil penalty until corrected. Repeat violations are $250.00 per violation and $100.00 per day until corrected.
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: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/26/2021 and conducted by Evaluator Jaylena Miller
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20210826154325

FACILITY NAME:PRIMROSE SCHOOL OF LIVERMOREFACILITY NUMBER:
013422060
ADMINISTRATOR:GUPTA, SHUBRAFACILITY TYPE:
850
ADDRESS:2901 LAS POSITAS RDTELEPHONE:
(925) 215-7372
CITY:LIVERMORESTATE: CAZIP CODE:
94551
CAPACITY:110CENSUS: 13DATE:
10/08/2021
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Shubra GuptaTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
facility failed to report to licensing
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/8/2021 at 8:30am Licensing Program Analyst (LPA) Jaylena Miller conducted an unannounced subsequent complaint investigation regarding the above allegation and met with Director Shubra Gupta and explained the purpose of the visit.
During the investigation LPA Miller conducted an interview with Director and Assistant Director. Director and Assistant Director admitted that there was a positive COVID reported at the facility on 8/12/2021, 8/14/2021, 8/17/2021 and 8/25/2021 and although the facility reported the positive case to the public health department, the facility failed to report the unusual incident to Community Care Licensing.

Based on LPA Miller’s interviews which were conducted, and records reviewed, the preponderance of evidence standard has been met, therefor the above allegation is to be SUBSTANTIATED. As a result, and per California Code of Regulations, Title 22 Division 12, Chapter 1, Section 101212(d) is being cited on LIC 9099-D. This report must remain on file for three years. The director was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. Notice of site visit was provided and must be posted for thirty days. Exit interview conducted with director, Shubra Gupta.

Please see LIC 9099-D for deficiency cited
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4