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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421389
Report Date: 05/24/2023
Date Signed: 05/24/2023 03:44:11 PM


Document Has Been Signed on 05/24/2023 03:44 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:NICOLE CUSTINOFACILITY TYPE:
830
ADDRESS:7110 KOLL CENTER PARKWAYTELEPHONE:
(925) 600-7745
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY:35CENSUS: 32DATE:
05/24/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Falguni BuddhevTIME COMPLETED:
04:00 PM
NARRATIVE
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On 05/24/2023 at 9:30am, Licensing Program Analysts (LPAs) Christina Uribe & Lorraine Dacanay Breaux visited the facility for the purpose of conducting an unannounced complaint investigation and a subsequent Case Management inspection and met with Assistant Director, Falguni Buddhev. Also present at the time of the inspection was 32 children and 7 staff in 3 classrooms. LPAs conducted a health and safety inspection of the facility.

During record review and observations made, the facility was found to be out of ratio in one classroom due to lack of teacher qualifications. In the Toddlers classroom, there were 14 infants and 1 teacher and 2 aides. LPAs reviewed personnel records to verify qualifications. The issuance of a Type B Violation is issued today for out of ratio due to more than 12 infants being directly supervised by one fully qualified teacher and two aides. Please see attached deficiency page for additional information.

Additionally, during record review, LPAs found that four staff members present during today's inspection did not have an eligible background clearance. The issuance of a Type A Violation is being issued today and the assessment of an immediate $500.00 civil penalty.

LPAs Uribe & Dacanay Breaux informed facility representative, Falguni Buddhev that this report dated 05/24/2034 documents one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.




***Continued on LIC 809C***
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2023
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 4


Document Has Been Signed on 05/24/2023 03:44 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 PLEASANTON
FACILITY NUMBER: 013421389

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2023
Section Cited
CCR
101416.5(b)(1)(A)

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101416.5 Staff-Infant Ratio: (b) there shall be a ratio of one teacher for every four infants in attendance. (1) An aide may be substituted for a teacher when all of the following is met. (A) There is a fully qualified teacher directly supervising no more than 12 infants.
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The director will review the regulations on ratio requirements and create a written statement detailing the facility's plan of action and protocols to ensure that ratio requirements are met at all times. The director will email this signed and written statement directly to LPA Dacanay Breaux
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This requirement was not met as evidenced by:

LPAs observed 14 infants in the care of one fully qualified teacher and two aides which poses a potential risk to the health, safety, and personal rights to children in care.
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at lorraine.dacanaybreaux@dss.ca.gov no later than the due date of 05/31/23.

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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 CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4


Document Has Been Signed on 05/24/2023 03:44 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 PLEASANTON
FACILITY NUMBER: 013421389

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/24/2023
Section Cited
CCR
101170(e)(1)

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101170 - Criminal Record Clearance: (e) All individuals subject to a criminal record review shall prior to working, residing, or volunteering in a licensed facility; (1) Obtain a criminal record clearance or a criminal record exemption as required by the Department.
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During the inspection, these uncleared staff members were removed from the facility and instructed to not return until their pending crimial background check is processed and they obtain an eligible clearance.
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This requirement was not met as evidenced by: LPAs observed four staff members present to have no eligible clearance which is an immediate health, safety, and personal rights risk to children in care.
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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 CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 PLEASANTON
FACILITY NUMBER: 013421389
VISIT DATE: 05/24/2023
NARRATIVE
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Also, LPAs Uribe & Dacanay Breaux informed the facility representative to provide a copy of this licensing report dated 05/24/2023 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Notice of Site Visit and Appeal Rights were given. Notice of Site Visit must be posted for 30 days. Failure to comply with posting requirements will result in the issuance of an immediate $100 civil penalty. Exit interview conducted and report was reviewed with the assistant director, Falguni Buddhdev.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4