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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422060
Report Date: 01/10/2023
Date Signed: 01/10/2023 02:19:12 PM


Document Has Been Signed on 01/10/2023 02:19 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



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: 98DATE:
01/10/2023
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Shubra GuptaTIME COMPLETED:
02:30 PM
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On January 10, 2023, Licensing Program Analyst (LPA) Simerjit Kaur conducted an unannounced Case Management Visit - Covid 19. LPA met with the Director Shubra Gupta and explained the nature of inspection. The facility was toured to conduct a Health and Safety Inspection. Present on this inspection were 10 staff and 98 preschool children. The facility operates from Monday to Friday 7:00 am to 6:00 pm.

Effective August 1, 2003 California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours and submit LIC 624 by fax, or mail. The facility was in compliance of the Reporting Requirement Regulation. No regulatory violation was observed at the time of the visit.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the facility representative, Shubra Gupta.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Simerjit KaurTELEPHONE: (510) 622-2632
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2023
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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