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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001093
Report Date: 10/17/2024
Date Signed: 10/17/2024 05:33:39 PM

Document Has Been Signed on 10/17/2024 05:33 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: 20CENSUS: 11DATE:
10/17/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:41 PM
MET WITH:Lynette JonesTIME VISIT/
INSPECTION COMPLETED:
05:50 PM
NARRATIVE
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On October 17, 2024, at approximately 4.00pm, Licensing Program Analysts (LPA)Tso met with Director, Lynette Jones. The purpose of inspection was explained 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 for the locations for fixture B (Child Day Care Areas), and fixture AA, where located at other part of the building i.e. Off-limit areas that was missing on the most recent retest report. Present in the facility was the director and 6 staff supervising 11 children (6 infants and 5 preschool aged children).

LPA observed that there is a smaller faucet installed next to the original faucet B. The Director stated that the original faucet B was not re-tested. The Director stated that the facility would remove the original faucet B and keeps the newly installed smaller faucet that was tested below ALE.

For the Fixture AA, it was locked in the Room 302 of the building with key access only by the authorized persons. LPA observed that the fixture AA’s water supply was shutdown only. The Director stated that the facility would permanently remove the faucet AA.

There were no deficiencies cited at this time under CCR, Title 22, Div. 12. 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: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2024
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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