Jefferson Care Home

Type of visit: Case Management - Other

On 08/05/2026 starting at 8:42 am, Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to conduct a case management inspection regarding facility closure. LPA rang the doorbell with no response. LPA looked through the glass of the front door and observed no one was present prior to licensee's arrival. Property was sold on 12/16/25. LPA will send forfeiture letter to licensee at a later time. Exit interview conducted. A copy of this report provided.the state’s words, verbatim · CDSS document, Aug 5, 2026

Type of visit: Required - 1 Year

On 5/07/25 at 9:30 am Licensing Program Analysts (LPA) J. Clancy-Czuleger arrived unannounced to do an annual inspection. LPA meet with Caregiver Dennis Ambat and explained the purpose of the visit. Licensee Stew Morris was informed of the visit. LPA inspected the facility inside out. There is no body of water. Physical plant is consistent with the facility sketch received by Central Application Bureau (CAB) and approved by the fire department. LPA inspected the living room, dining area, kitchen, bedrooms, hallways, bathrooms, side and backyards. Bedrooms were observed appropriately furnished with adequate lighting and drawers. Facility has sufficient towels, extra bed sheets and comforters. Equipment and supplies for residents' personal hygiene are available and on site. Dinner and silver wares were observed sufficient for residents' use. Food supplies checked and observed good for seven days of non-perishables. Facility was observed equipped with refrigerator, microwave, dishwasher, washer and dryer. Cabinet for knives, cleaning supplies, and central storage for medications were observed with locks. Activity supplies were available. Outdoor activity space was observed furnished with tables, chairs and shade. The facility has a mitigation plan. At 9:50 am LPA reviewed 3 residents records. At 10:15 am, LPA reviewed 2 staff records and 2 of 2 were fingerprint cleared and associated to the facility. Continued on LIC809C... Continued from LIC-809 The following deficiency was observed during the visit: The facility does not employ enough staff for residents in care The facility is un-kept with a broken fence/ unmaintenanced yard Fire extinguisher has not been replaced or serviced There is not a current administrator certificate Administrator qualifications The facility does not have updated Liability insurance Civil Penalties in the total amount of $500.00 is assessed today for repeat deficiencies.The Facility was cited, and citations can be found on the LIC 809-D. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, May 7, 2025

Type of visit: Case Management - Deficiencies

On 03//2025 at 1:30 PM Licensing Program Analysts (LPA) J. Clancy-Czuleger arrived unannounced to conduct a Case Management. LPA met with Dennis Ambat, Caregiver. While at the facility for proof of corrections visit LPA J. Clancy-Czuleger observed that administrator Stewart Morris's administrator certificate is no longer active as of 3/7/2025. Stewart Morris is not on the pending renewals application list or the active certificate list. The deficiency was observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Mar 20, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87407(d) · Plan of correction due date: Apr 3, 2025

87407 Administrator Recertification Requirement (d) To apply for recertification prior to the expiration date of the certificate, ...post-marked on, or up to ninety (90) days before, the certificate expiration date. This requirement is not met as evidenced by: Based on observation and interviews, Licensee failed to have Administrator's Certificate renewed prior to expiration date which poses a potential health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Mar 20, 2025

Plan of correction: By POC date administrator agrees to submit the required documentation to start the certificate renewal process.

Type of visit: POC

On 03/20/2025 at 1:30 PM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger arrived unannounced to conduct a Plan of Correction (POC) visit. LPAs met with caregiver Dennis Ambat and explained the purpose of the visit. On 03/06/2025, LPA conducted a complaint investigation and case management visit in which deficiencies were cited. The POC due dates was 03/07/25, 03/08/25, and 03/13/25. Administrator failed to submit the POC by the due dates and this is why LPAs came to make a POC visit. Deficiencies not cleared: 1569.695(d)= $100 X 12 = $1200.00 1569.695(b)= $100 X 12 = $1200.00 1569.185(a)(1)= $100 X 7 = $700.00 87468.1(a)(3)= $100 X 12 = $1200.00 87555(b)(26)= $100 X 7 = $700.00 87555(a)= $100 X 7 = $700.00 1569.695(2)= $100 X 13 = $1300.00 Civil Penalties in the total amount of $7000.00 is assessed today for failure to meet POC date for deficiencies. Facility is subject to ongoing daily civil penalties until deficiencies is corrected. Exit interview conducted. A copy of this report, appeal rights provided and LIC421FC provided.the state’s words, verbatim · CDSS document, Mar 20, 2025

Allegation investigated: Licensee did not ensure the facility had power

On 3/6/2025 at 9:00AM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger and Y. Brown arrived unannounced to deliver findings for the above allegations. LPA explained the purpose of the visit with Caregiver Dennis Ambat. Administrator Stew Morris was informed of the visit. On the allegation: Licensee did not ensure the facility had power. LPA interviewed staff, residents and witnesses about the loss of power in February 2025. LPA was informed that the facility was without power for over a week and because the licensee did not pay the bill. During this time no alternative power resource was provided during the outage. Based on LPAs interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D. Exit interview conducted. Appeal Rights and a copy of this report provided. Substantiatedthe state’s words, verbatim · CDSS document, Mar 6, 2025 · control 15-AS-20250210154802

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.695(2) · Plan of correction due date: Mar 7, 2025

Plans for the facility to be self-reliant for a period of not less than 72 hours immediately following ... a short-term or long-term power failure. If the facility plans to shelter in place ... Shall have a plan and supplies available to provide alternative resources during an outage. This requirement was not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above by not having a plan and supplies available to provide alternative resources during an outage which poses/posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 6, 2025

Plan of correction: The facility agrees to purchase an alternative resource for power for the facility to be used in short-term or long-term power failure. Proof of correction will be sent to CCLD by POC date

Allegation investigated: Licensee is not ensuring that the facility has adequate amount of food Facility staff are not serving nutritious meals Facility staff speak inappropriately to residents in care

On 03/06/2025 at 09:00AM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger and Y. Brown arrived unannounced to conduct a complaint visit. LPA explained the purpose of the visit with Caregiver Dennis Ambat. Administrator Stew Morris was informed of the visit. During the initial 10-day complaint visit LPAs toured the facility and interviewed staff, and residents. LPAs observed two refrigerators with minimal food in them. The produce that was observed in the kitchen was three lemons and two bags of lettuces. S2 stated that shopping is done every two weeks. In interviews with residents LPAs found that S1 frequently yells and curses in fromt of and at residents. Based on LPAs interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D. Exit interview conducted. Appeal Rights and a copy of this report provided. Substantiatedthe state’s words, verbatim · CDSS document, Mar 6, 2025 · control 15-AS-20250225102154

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Mar 8, 2025

To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination.This requirement was not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above by yell and curse in front of and at residents in care which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 6, 2025

Plan of correction: The facility agreees to have all staff read the regulations, obtain personal rights training from a CCLD approved vendor. Screaming and/or yelling shall cease immediately. Proof of completed training by those listed above to be submitted by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(26) · Plan of correction due date: Mar 13, 2025

Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement was not met as evidenced by: Based on observations, the licensee did not comply with the section cited above by not having two days of perishable foods in the refrigerators which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 6, 2025

Plan of correction: The facility agrees to purchase perishable food supply and submit photo of food and receipt. Proof of correction will be sent to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(a) · Plan of correction due date: Mar 13, 2025

The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council...This requirement was not met as evidenced by: Based on record review, the licensee did not comply with the section cited above by not having fresh fruit or vegetables for residents which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 6, 2025

Plan of correction: The facility agrees to purchase a varity of food supply and submit photo of food and receipt. Proof of correction will be sent to CCLD by POC date.

Type of visit: Case Management - Deficiencies

On 03/06/2025 at 09:00 am Licensing Program Analysts (LPA) J. Clancy-Czuleger and Y. Brown arrived unannounced to conduct a Case Management. LPA met with caregiver Dennis Ambat. Administrator Stew Morris was informed of the visit. While LPA J. Clancy-Czuleger conducted a complaint investigation (15-AS-20250210154802) on 2/20/2025, LPA was informed that the administrator had not been to the facility in over a month, the administrator did not provide assistance to staff during a power outage and did not give instructions on relocation, the facilities emergency disaster was not up to date, staff have not received training for emergency disasters, annual fee has not been paid. The deficiency was observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Mar 6, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 1569.695(d) · Plan of correction due date: Mar 8, 2025

A facility shall review the plan annually and make updates as necessary, including changes in floor plans and the population served. The licensee or administrator shall sign and date documentation to indicate that the plan has been reviewed and updated as necessary. This requirement was not met as evidenced by: Not having an updated emergency disaster plan at the facility.the state’s words, verbatim · CDSS document, Mar 6, 2025

Plan of correction: The Facility agrees to fill out the updated emergency disaster plan. Proof of correction will be sent to CCLD by POC date

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.695(b) · Plan of correction due date: Mar 8, 2025

A facility shall provide training on the plan to each staff member upon hire and annually thereafter. The training shall include staff responsibilities during an emergency or disaster. This requirement was not met as evidenced by: Staff not known what to do or where to go during a multi day power outage at the facility.the state’s words, verbatim · CDSS document, Mar 6, 2025

Plan of correction: The facility agrees to conduct in-service training on staff responsibilities during a disaster drill. document and email CCLD a copy of the sign in sheet with topic of training date, time and name of trainer no later than the POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 1569.185((a)(1) · Plan of correction due date: Mar 13, 2025

An application fee adjusted by facility and capacity shall be charged by... After initial licensure, a fee shall be charged by the department annually on each anniversary of the effective date of the license.This requirement was not met as evidenced by: LPA conducted records check via LIS which revealed outstanding annual fees due to the department which poses a potential risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Mar 6, 2025

Plan of correction: Facility agrees to pay the outstanding annual fee. Proof of correction will be sent to CCLD by POC date.

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 6/14/24 at 1:50 pm Licensing Program Analysts (LPA) J. Clancy-Czuleger arrived unannounced to do an annual inspection. LPA meet with caregiver Dennis Ambat and explained the purpose of the visit. LPA inspected the facility inside out. There is no body of water. Physical plant is consistent with the facility sketch received by Central Application Bureau (CAB) and approved by the fire department. LPA inspected the living room, dining area, kitchen, bedrooms, hallways, bathrooms, side and backyards. Bedrooms were observed appropriately furnished with adequate lighting and drawers. Facility has sufficient towels, extra bed sheets and comforters. Equipment and supplies for residents' personal hygiene are available and on site. Dinner and silver wares were observed sufficient for residents' use. Food supplies checked and observed good for seven days of non-perishables. Facility was observed equipped with refrigerator, microwave, dishwasher, washer and dryer. Cabinet for knives, cleaning supplies, and central storage for medications were observed with locks. Activity supplies were available. Outdoor activity space was observed furnished with tables, chairs The following deficiencies were observed: Board blocking back door Fire extinguishers does not have tag The Facility was cited, and citations can be found on the LIC 809-D. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 14, 2024