384001093-2-15-2024-05-CC-MTSO-D2H3YW-20240215174037

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384001093
Report Date: 02/15/2024
Date Signed: 02/15/2024 05:40:47 PM

Document Has Been Signed on 02/15/2024 05:40 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
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: 10	DATE:	02/15/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	02:26 PM
MET WITH:	Lynette, Jones		TIME COMPLETED:	05:50 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 February 15, 2024, approximately 8.40am, Licensing Program Analysts (LPAs) Mok and Tso met with the Director, Lynette, Jones, Executive Director, Sister Betty Dunkel and Facility Manager, Tarl Leonard, for an unannounced required annual inspection and case management for decrease in capacity. The purpose of the inspection was explained. This is an infant Center that is licensed for a total capacity of 39. Today, there are 10 infants supervised by 5 staff. The facility complies with the required teacher-infant ratios today. The hours of operation are Monday to Friday, 8:30 am to 5:30 pm. LPAs evaluated the Center for Health and Safety Hazards along with the Director. The facility maintains a proper record of sign-in/out for infants, and all parent signatures match the number of infants present. The environment of the infants' classroom appeared clean and organized, with appropriate heating, lighting, and ventilation. The Center provides age-appropriate toys, furnishings, changing tables, and equipment. LPA did not observe any pools, spas, or any other bodies of water, nor did they notice any bouncers, exersaucers, or similar equipment at the facility. According to the Director, no firearms or weapons are present at the Center, and all cleaning materials and potentially hazardous objects are kept out of reach of children. Personnel restrooms are separate from children, and all solid waste storage containers have tightly fitted lids. The Center also maintains a carbon monoxide detector, centralized smoke alarm, fully equipped fire extinguisher, and First Aid kit. Designated cubbies are available for children to store their belongings. There is a designated area where infants can rest or nap without being distracted or disturbed. The area is equipped with sufficient sleeping equipment and cots for each child, and all mats and bedding are stored in their appropriate location. As stated by the Director, the parents provide bedding and other necessary sleeping equipment. Additionally, the napping equipment and mattresses are washed and cleaned weekly. LPA has reminded the Director that emergency exits must always remain clear, and that cots and cribs cannot be placed in a manner that obstructs emergency exits. (Continued on page 2...)

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

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 5

Document Has Been Signed on 02/15/2024 05:40 PM - It Cannot Be Edited

Created By: Man Tso On 02/15/2024 at 04:42 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: 02/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based upon record review, the facility did not test for lead until 1/7/2024, which posed a potential health, safety, or personal rights risk to the persons in care.
	POC Due Date: 02/29/2024
	Plan of Correction
1 2 3 4	Director will have water outlets tested for lead contamination by the due date: 02/29/2024. Proof of correction will be submitted to the department via email.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: 02/15/2024

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
26
27
28
29
30
31
32

(Continued, page 2...)
Per Director, the facility provides disposable diapers and wipes for their infants at the center. The facility has a designated changing table, equipped with at least 1" thick padding and covered with disposable paper. Additionally, the changing tables are designed with at least 3" elevated edges to prevent accidents. Disposable wipes are used to clean the area after each use. The Director has been reminded that the diaper changing area and sink must be reserved for their intended use only. It is imperative that they are not used for food preparation or as a counter to store classroom activities or teacher resources.

During the observation by LPA, it was noted that the formula milk provided by the facility was stored appropriately in the refrigerator, and each bottle was labeled accordingly. Plastic baby water bottles or cups with lids are used to provide drinking water for the infants. The food preparation site is kept clean, organized, and inaccessible to children.

The outdoor surface area appears to be well-maintained and in good condition. It's covered with soft rubber materials, making it a safe and comfortable space for infants to play. Age-appropriate structures were observed in the play yard, appearing sturdy and in good condition.

LPA checked the personnel and 6 children's records at the facility. A sample of children's files contained complete information such as medical assessments, needs, services, feeding plans, and signed admission agreements. The staff files were well-organized and thorough, with proof of educational credentials. Multiple staff members were observed to have valid CPR/First Aid certificates.

Additionally, the facility had posted the required documents, including the license, menus, waivers, Notification of Parental Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan. The Director stated that fire and earthquake drills are conducted at least once every six months, with the most recent fire drill being held on January 21, 2024.
(Continued on page 3...)

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: 02/15/2024

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
26
27
28
29
30
31
32

(Continued, page 3...)
LPA discussed the safe sleep regulations with the Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA reminded the Director that as of September 1, 2016. A person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles.

This facility does not provide Incidental Medical Services (IMS). The IMS policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US
Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

The Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA referred the director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information. LPAs searched on the webpage of Child Care Center Lead Sampling and Reporting Tool on 02/14/24, no record was found. Type B deficiency citation was issued. (Please refer to LIC809D).
Continued on page 4...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: 02/15/2024

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
26
27
28
29
30
31
32

Continued, page 4…
The Director was informed about Mandated Reporter training available on the CCLD website. In addition to AB1207 training required to be completed every two years by all staff hired a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. Also, the Director was reminded of Pesticide training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare

The Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

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 on, or immediately adjacent to, the interior side of the main door 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: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

LIC809 (FAS) - (06/04)

Page: 5 of 5