Epione Residential Care

Type of visit: Required - 1 Year

On 02/25/2026, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced Annual Required – 1yr. inspection for this facility and was greeted by administrator/licensee Lilibeth Jacobs. The facility currently provides care for 5 residents, and 3 staff. Facility is licensed for ages 60 and over. 6 residents may be non-ambulatory and 1 bedridden resident. There are no residents that are bedridden. There is a hospice waiver on file for 3 hospice residents. As of today's visit, there are no residents on hospice. This is a single level facility with 6 resident bedrooms. LPA toured the facility with Lilibeth, and the facility is found to be clean and at a comfortable temperature with all emergency exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas are inspected. LPA observed 2 fire extinguishers located through out the facility. All observed are charged with inspection tags of 11/03/2025. LPA observed the kitchen, garage, and laundry are are found to be in operable condition, organized, and clean. Carbon monoxide detectors are located through out with combination smoke and fire detectors that are hard wired through out. Resident restrooms and full bathrooms are observed at random. Showers are equipped with non-skid flooring or mats and grab bars for accessibility. Water temperature is tested in two resident full bathrooms at 116F and another is measured at 115F. Resident bedrooms are observed to be fully furnished with items outlined in Title 22 and all furniture is in good condition. Linen closets are observed to be fully stocked with supplies for residents. Continued on next page... Page 2 There is sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations, with food stored in the kitchen and garage being sufficient for residents in care. Food supply is replenished regularly. There are additional refrigerator and freezer in the garage and both are observed to be fully stocked with resident food supplies. Cleaning supplies and other toxins are safely stored in locked closets in the garage and kitchen. There is a supply of hygiene products and paper products available for residents. Medication cabinets are observed in the kitchen as locked not accessible to residents in care. PPE is observed as stored and in place in the garage and gowns being stored in an exterior facility storage shed. A random audit of medications is conducted and found that all medication counts and records are in order. LPA conducted a sample file review for residents and found all items to be in order including medical assessments and needs & service plans. Upon review of staff files, LPA found that caregiver staff have annual training and current 1st aid and CPR on file and current. Last disaster drill conducted was in 12/16/2025 which was an earthquake drill. Administrator certificate is observed to be current expiring 01/16/2027. No deficiencies cited during today's visit. Report is reviewed with Lilibeth and a copy is provided.the state’s words, verbatim · CDSS document, Feb 25, 2026

Type of visit: Required - 1 Year

On February 13, 2025, at 08:50 AM, the Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. The LPA met with the Administrator, Lilibeth Jacobs, and disclosed the purpose of the inspection. The Administrator informed the LPA that the facility had (5) residents in care and (2) staff members present at the time. At 9:16 AM, the LPA initiated a walk-through of the facility, accompanied by the Administrator. LPA inspected the kitchen and found it clean, with no food preparation and cooking in progress at the time. The appliances were checked and observed to be in working order. The LPA inspected a locked cabinet containing knives and sharp objects, and a locked cabinet next to the sink with detergents, disinfectants, and cleaning supplies. The refrigerator and pantry cabinets were inspected, and sufficient supplies of fresh perishable food for (2) days and nonperishable staples for (7) days were observed. No expired food or stored medications were noted. LPA inspected the dining area adjacent to the kitchen and found it clean. The dining table and chairs were observed to accommodate the residents, and all the furniture was in good repair. LPA inspected the fire extinguisher mounted on the wall in the dining area and found it fully charged, with the last service tag dated 11/08/2024. The Administrator tested the smoke and carbon monoxide detector located in the kitchen area in the LPA's presence, and it was found to be functional. Additional smoke and carbon monoxide detectors were observed in all bedrooms and common areas of the facility during the visit. LPA inspected the living room and observed it clean, with all furniture in good repair. There were sofa sets, chairs, a coffee table, a piano, and a television in the living room. (1) resident was observed watching TV. Video cameras were observed in the living room, dining area, and other common areas of the facility, for which the Administrator had obtained signed acknowledgment document from the resident/authorized representative. Continued on LIC809-C There were (5) bedrooms and (2½) bathrooms designated for residents' use. (4) resident rooms were single occupancy and (1) room was shared occupancy. (1) bathroom was common and (1½) bathrooms were private. LPA inspected all (5) resident rooms and found them clean, well-lit, and equipped with the required furniture. All exit doors were connected to centrally monitored system for notification. LPA inspected (2) full bathrooms and found them clean, sanitary, and in good working condition. The bathrooms contained soap, grab bars, paper towels, a trash can, a shower chair, and non-slip mats. The hot water temperature at the sink faucet measured 108.5°F in bathroom #1 and 110.7°F in bathroom #2. LPA inspected the (2) storage closets in the hallway and observed them contained clean linens, blankets, and towels for residents’ use. LPA inspected the garage and found it clean. A washer, a dryer, a refrigerator, a freezer containing additional food supplies, and storage racks shelves with non-perishable food items, incontinence supplies, and paper products were observed. LPA toured the backyard area and found ramps and passageways in good condition, clear of obstructions, with no blocking or tripping hazards. The backyard has a set of a patio table, chairs, and shaded areas for resident use. No bodies of water and no tripping hazards were noted. LPA inspected (1) storage shed and observed wheelchairs, furniture items, outdoor furniture, and gardening products stored in the shed. LPA reviewed (6) staff personnel records and (5) resident records. The LPA observed that 5 of 5 residents had an Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, and CSDMR. LPA observed that 6 of 6 staff members had LIC 508 Criminal Record Statements and LIC 503 Health Screening and confirmed that 6 of 6 staff members were associated with the facility. LPA observed a locked centrally stored medication cabinet inside the dining area. Medications were organized in separate bins for each resident. All medication bottles were properly labeled. Centrally Stored Medication Records were reviewed and found to be complete. LPA inspected the first aid kit and found it fully stocked. Emergency Drill Logs were reviewed, and it was observed that Emergency Disaster Drills were conducted quarterly, with the most recent drill completed on 12/18/2024. Continued on LIC809-C The following updated forms are requested to be submitted to CCLD by 02/20/2025: LIC 500: Personnel Report LIC 308: Designation of Facility Responsibility Certificate of Liability Insurance Current Property Lease Agreement Administrator Certificate(s) No deficiencies were cited during today's visit. An exit interview was conducted with the Administrator. A copy of this report was left with the Administrator, Lilibath Jacobs, whose signature on this form confirms receipt of the report.the state’s words, verbatim · CDSS document, Feb 13, 2025

Type of visit: Required - 1 Year

On 1/20/24, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA introduced self, stated purpose of visit, and allowed entrance by Licensee Lilibeth Jacobs. Lilibeth Jacobs also serves as facility Administrator, #6050851740 expires 1/15/2025. There are currently six (6) residents in care. Five (5) residents were present during today's inspection. Residents were observed to be visiting with family, and relaxing in their bedrooms. Facility tour conducted with licensee. Facility has all private bedrooms. Facility observed to be in good repair, well lit, have adequate seating in all common areas, comfortable temperature, and to be odor free. All resident bedrooms observed to be fully furnished. Bathrooms toured, showers observed to have shower chairs, grab bars, and non-skid mats available. Toilet area also observed to have grab bars. Water temperature measured in bathroom at 116 degrees F. Kitchen toured, facility observed to have adequate food supply for residents in care. All sharps observed to be locked and secured in kitchen drawer. Cleaning supplies in kitchen cabinet are locked, secured, and inaccessible to residents. Garage is utilized as laundry room and additional storage, observed to be locked, secured, and inaccessible to residents. Medications observed to be locked and secured in dining room cabinet. Fire extinguisher present with a purchase date of 11/06/23. Carbon monoxide detector and smoke detector observed operational during inspection. Facility is also equipped with a pull station. Last fire drill conducted on 12/17/23 according to facility records. Outside of facility toured. No obstructions or hazards observed. The following documents were submitted to San Bruno Regional Office in 9/2023: LIC 500, LIC 308, LIC 400, LIC 610E, LIC 503 for staff, copy of Administrator Certificate and copy of Liability Insurance. LPA received updated copy of LIC 9020 during facility inspection. No deficiencies observed during inspection.the state’s words, verbatim · CDSS document, Jan 20, 2024