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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001093
Report Date: 05/30/2024
Date Signed: 05/30/2024 01:04:50 PM

Document Has Been Signed on 05/30/2024 01:04 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 CENTERFACILITY NUMBER:
384001093
ADMINISTRATOR/
DIRECTOR:		LYNETTE JONESFACILITY TYPE:
830
ADDRESS:100 MASONIC AVENUETELEPHONE:
(415) 567-8370
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94118
CAPACITY: 30TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
05/30/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:14 PM
MET WITH:Lynette JonesTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
NARRATIVE
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On May 30, 2024, at approximately 11.25am, Licensing Program Analysts (LPA)Tso met with Director, Lynette Jones. The purpose of inspection was explained and was for an unannounced, case management inspection to follow up 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 6 staff supervising 13 children (5 infants and 8 preschool aged children).

Further to the facility’s retest on the water outlets on 4/13/2024, the facility received the report from the Vendor on April 25, 2024. There are still 17 fixtures’ test results 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
6.6

Other part of the building (Off-limit areas)

Fixture Result (ppb) FixtureResult (ppb)FixtureResult (ppb)
S
6.3
T
8.5
U
20
V
7.6
X
14
V
5.6
Z
7
AA
17
DD
7.5
EE
7.1
FF
17
HH
11
II
12
JJ
8.4
KK
24
MM
9.4
(Continued on page 2 …)
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE: DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2024
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: 05/30/2024
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(Continued, page 2 …)

LPA had a meeting with the Director, Lynette Jones, Executive Director, Sister Betty Dunkel, and Technical Manager, Tarl Leonard to discuss the coming plan to fix the remaining 17 affected fixtures that triggered the ALE.

The facility proposed to install the filters with electronic alert function to remind the staff of the facility to change filter that used for drinking and food preparation. There were some affected fixtures, including the Fixture B in Room 125 (daycare area) to be installed filters.

For the rest of the affected fixtures, they would be permanently removed. LPA reminded the Director that posting a post stating “Not for drinking and/or food preparation” on the affected fixtures is insufficient. Some mechanically works making the affected fixtures not functionable were needed.

There were no deficiencies cited at this time under CCR, Title 22, Div. 12, Chapter 3. A copy of today’s report was given to the Director.

Notice of site visit was given 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: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024
LIC809 (FAS) - (06/04)
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