384001093-2-22-2024-05-CC-MTSO-D2Q396-20240222170238

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384001093
Report Date: 02/22/2024
Date Signed: 02/22/2024 05:02:46 PM

Document Has Been Signed on 02/22/2024 05:02 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	EPIPHANY PARENT-CHILD CENTER		FACILITY NUMBER:	384001093
ADMINISTRATOR:	LYNETTE JONES		FACILITY TYPE:	830
ADDRESS:	100 MASONIC AVENUE		TELEPHONE:	(415) 567-8370
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94118
CAPACITY: 39	TOTAL ENROLLED CHILDREN: 39	CENSUS: 6	DATE:	02/22/2024
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	03:40 PM
MET WITH:	Lynette Jones		TIME COMPLETED:	05:10 PM

NARRATIVE

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On February 22, 2024, at approximately 1.50pm, Licensing Program Analysts (LPA)Tso met with Director, Lynette Jones and Technical Manager, Tarl Leonard. The purpose of inspection was explained and was for an unannounced, case management inspection for the Action Level Exceedance (ALE) of Lead in Child Care Center's water. LPA was given a tour of the facility. Present in the facility was the director and 5 staff supervising 6 infants.

LPA discussed the new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requires the Lead Testing of water in the Child Care Center with the Director during the inspection. All Child Care Centers that are located in buildings constructed before January 1, 2010, must have their water tested and post the results by January 1, 2023, and every 5 years after the date of the first testing.

The facility received the ALE report from the Vendor on January 07, 2024. Test results for this facility that exceeded a higher level of parts per billion (ppb) allowed, 5.5 ppb. The affected fixtures are as follows.

Child Day Care Areas:

Fixture	Result (ppb)
B	8.9

(Continued on page 2 …)

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: EPIPHANY PARENT-CHILD CENTER	FACILITY NUMBER: 384001093
	VISIT DATE: 02/22/2024

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(Continued on page 2 …)
Other parts of the building (Off-limit areas)

Fixture	Result (ppb)	Fixture	Result (ppb)	Fixture	Result (ppb)
NN	20	I	630	J	1,400
K	6.9	L	11	N	8.2
S	16	T	25	U	39
V	14	W	1,400	X	32
Y	16	Z	290	AA	390
CC	7.4	DD	24	EE	44
FF	250	HH	28	II	31
JJ	22	KK	130	MM	24

Only the fixture B (8.9 ppb) is in the child day care area. The Director proactively temporarily made it inaccessible by removed the faucet and using a 5-gallon bottle dispenser to provide the water for the infants. The source of the water is collected from the Fixture D (1ppb) which is not the ALE of lead water. The rest of the above-mentioned affected fixtures are in the other parts of the building where are the off-limit areas of the facility. The Director made the affected fixtures inaccessible by removed all the faucets until replaced the new ones and retested with results below 5.5ppb. Per the director, the written plan of fixing all the affected fixtures, including retesting the samples will be submitted to the Licensing Office tomorrow (2/23/2024). The schedule summary is as follows.

· 03/01/2024: installation of the new faucets
· 03/02-29/2024: flushing period
· 03/30/2024: retest

Per the updated guidance on written directives in PIN 21-21.1-CCP, facility will be cited for the actionable level exceedance of the fixtures.

Please refer to LIC 809D for today’s citation. A copy of today’s report and the facility’s appeal rights were discussed and given to the Director. The Notice of Site Visit was given to the director and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Lynette Jones.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/22/2024 05:02 PM - It Cannot Be Edited

Created By: Man Tso On 02/22/2024 at 04:13 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: EPIPHANY PARENT-CHILD CENTER	FACILITY NUMBER: 384001093
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/22/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/22/2024 Section Cited 101700.3(b)(1)	1 2 3 4 5 6 7	101700.3 California Lead Action Level at Child Care Centers (b)(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The Director stated that the facility would replace the affected fixtures and will schedule a retest with certified water samplers. The Director will submit the plan of fixing the affected faucets with the date for retest by 2/23/24, and update the LPA for the retest results, once available.
	8 9 10 11 12 13 14	Based on results received from the certified water samplers, the facility did not ensure the lead in their water source below 5.5 ppb, which poses/posed a potential health, safety, or personal rights risk to persons in care.	8 9 10 11 12 13 14	The retest results will be forwarded to the department by the set due date.
	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:

Garfield Leung

LICENSING EVALUATOR NAME:

Man Tso

LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024

LIC809 (FAS) - (06/04)

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