Addis Home Care

Type of visit: POC

Licensing Program Analyst (LPA) Michael Hood arrived at the care home and met with Licensee, Yenne Tezera, to conduct a plan of correction (POC) visit to follow-up on a citation issued during an inspection conducted on April 9, 2026. During visit conducted on April 9, 2026, LPA issued a deficiency with the POC that the facility would refund resident (R1’s) authorized representative fees paid from February 10, 2026 to February 28, 2026 and would submit proof to the Department that refund was issued by POC due date of June 9, 2026. During today’s visit, LPA inquired Licensee whether they refunded R1’s authorized representative fees paid from February 10, 2026 to February 28, 2026. Licensee stated that they had yet to issue a refund to R1's authorized representative as of today's date. Prior to visit conducted on April 9, 2026, Relevant party reported that R1 resided at the facility from February 1, 2026 to February 7, 2026. R1 passed away on February 7, 2026. Relevant party reported that R1’s authorized representatives did not receive a prorated refund for rent that was paid in advance for the month of February, 2026. Interview with Licensee indicated that R1 was admitted to the facility on January 31, 2026 and passed away on February 7, 2026. Licensee indicated that they had not issued a refund to R1’s authorized representatives as the facility did not issue refunds upon the death of a resident receiving hospice services per admission agreement signed by R1’s authorized representative. ** Report continued on 809-C ** LPA reviewed Admission Agreement signed by R1’s authorized representative, which states “REFUND POLICY: Refund policy for this facility is ‘Please note that payment are not refundable & a 30 days notice is required for any cancellations/changes.’” Per Health and Safety Code §1569.652(c), “A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed.” Per Title 22, Division 6, Chapter 8, Section 87507(h)(4), “The admission agreement shall not contain the following: Any provision that violates the rights of any residents including but not limited to those specified in Section 87468 and in Health and Safety Code section 1569 et seq.” Relevant party reported that R1’s property was removed from their room to the garage on February 8, 2026 and R1's Power of Attorney removed R1's property from the care home on February 10, 2026. Licensee stated that R1's property was removed from the care home on February 9, 2026. As a result of today's inspection, a deficiency is being cited pursuant to Health and Safety Code section 1569.652 regarding termination of admission agreement upon death of resident. A civil penalty in the amount of $250 is assessed for today's date due to repeat violation. Deficiency is listed on 809-D page. Exit interview was conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Sep 29, 2026

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Oct 5, 2026

§1569.652 Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds (c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, the facility did not ensure to issue a refund for advance fees paid to R1’s authorized representative upon the removal of R1’s property after they passed away, which poses a potential health, safety, and/or personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Sep 29, 2026

Plan of correction: Facility will refund R1’s authorized representative fees paid from February 10, 2026 to February 28, 2026. Facility will contact R1's authorized representative to establish refund payments and when refund shall be completed by POC due date of October 5, 2026. Facility will submit proof of correspondence to LPA by POC due date. A civil penalty in the amount of $250 is assessed for today's date due to repeat violation.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Hood arrived at the care home unannounced on September 29, 2026 to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are four (4) bedrooms and two (2) bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 117 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on site. LPA observed knives, cleaning products, and other toxins to be locked away and inaccessible to residents. LPA observed the backyard and perimeter of the care home to be free of clutter and debris. LPA observed emergency exits to be unobstructed. LPA observed smoke detectors and carbon monoxide detectors to be operational in the care home. First aid kit is maintained and ready for emergency use. LPA reviewed two (2) residents' medications and observed medication storage to be locked away and inaccessible to the residents. LPA reviewed three (3) resident files and two (2) staff files. LPA requested copies of the facility's emergency disaster plan and staff roster during visit. As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit was interview conducted and copy of report given at the conclusion of this visit.the state’s words, verbatim · CDSS document, Sep 29, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Caregiver, Millicent Brown, to obtain a signature relative to amending a report for an inspection conducted on April 9, 2026. During visit, LPA spoke with Licensee, Yenne Tezera, via telephone call, who gave permission to have caregiver sign report. Signature was obtained for amended document during visit. Exit interview was conducted. A copy of this report and was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, May 6, 2026

Allegation investigated: Staff are not providing resident's authorized representative with a refund

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Licensee, Yenne Tezera, to deliver findings regarding the complaint allegation listed above. During the investigation, LPA conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: Allegation: Staff are not providing resident's authorized representative with a refund Relevant party reported that resident (R1) resided at the facility from February 1, 2026 to February 7, 2026. R1 passed away on February 7, 2026. Relevant party reported that R1’s authorized representatives did not receive a prorated refund for rent that was paid in advance for the month of February, 2026. ** Report continued on 9099-C ** Substantiated Interview with Licensee indicated that R1 was admitted to the facility on January 31, 2026 and passed away on February 7, 2026. Licensee indicated that they had not issued a refund to R1’s authorized representatives as the facility did not issue refunds upon the death of a resident receiving hospice services per admission agreement signed by R1’s authorized representative. LPA reviewed Admission Agreement signed by R1’s authorized representative, which states “REFUND POLICY: Refund policy for this facility is ‘Please note that payment are not refundable & a 30 days notice is required for any cancellations/changes.’” Per Health and Safety Code §1569.652(c), “A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed.” Per Title 22, Division 6, Chapter 8, Section 87507(h)(4), “The admission agreement shall not contain the following: Any provision that violates the rights of any residents including but not limited to those specified in Section 87468 and in Health and Safety Code section 1569 et seq.” Relevant party reported that R1’s property was removed from their room to the garage on February 8, 2026 and R1's Power of Attorney removed R1's property from the care home on February 10, 2026. Licensee stated that R1's property was removed from the care home on February 9, 2026. Based on interviews conducted and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per Health and Safety Code, a deficiency is being cited on the attached 9099-D page. Exit interview was conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Apr 9, 2026 · control 59-AS-20260304105150

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Jun 9, 2026

§1569.652 Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds (c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, the facility did not ensure to issue a refund for advance fees paid to R1’s authorized representative upon the removal of R1’s property after they passed away, which poses a potential health, safety, and/or personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Apr 9, 2026

Plan of correction: Facility will refund R1’s authorized representative fees paid from February 10, 2026 to February 28, 2026. Facility will submit proof that refund was issued by POC due date of June 9, 2026.

Allegation investigated: Staff are not providing resident's authorized representative with a refund

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Licensee, Yenne Tezera, to deliver findings regarding the complaint allegation listed above. During the investigation, LPA conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: Allegation: Staff are not providing resident's authorized representative with a refund Relevant party reported that resident (R1) resided at the facility from February 1, 2026 to February 7, 2026. R1 passed away on February 7, 2026. Relevant party reported that R1’s authorized representatives did not receive a prorated refund for rent that was paid in advance for the month of February, 2026. ** Report continued on 9099-C ** Substantiated Interview with Licensee indicated that R1 was admitted to the facility on January 31, 2026 and passed away on February 7, 2026. Licensee indicated that they had not issued a refund to R1’s authorized representatives as the facility did not issue refunds upon the death of a resident receiving hospice services per admission agreement signed by R1’s authorized representative. LPA reviewed Admission Agreement signed by R1’s authorized representative, which states “REFUND POLICY: Refund policy for this facility is ‘Please note that payment are not refundable & a 30 days notice is required for any cancellations/changes.’” Per Health and Safety Code §1569.652(c), “A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed.” Per Title 22, Division 6, Chapter 8, Section 87507(h)(4), “The admission agreement shall not contain the following: Any provision that violates the rights of any residents including but not limited to those specified in Section 87468 and in Health and Safety Code section 1569 et seq.” Relevant party reported that R1’s property was removed from their room to the garage on February 8, 2026 and R1's Power of Attorney removed R1's property from the care home on February 10, 2026. Licensee stated that R1's property was removed from the care home on February 9, 2026. Based on interviews conducted and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per Health and Safety Code, a deficiency is being cited on the attached 9099-D page. Exit interview was conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Apr 9, 2026 · control 59-AS-20260304105150

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Jun 9, 2026

§1569.652 Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds (c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, the facility did not ensure to issue a refund for advance fees paid to R1’s authorized representative upon the removal of R1’s property after they passed away, which poses a potential health, safety, and/or personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Apr 9, 2026

Plan of correction: Facility will refund R1’s authorized representative fees paid from February 10, 2026 to February 28, 2026. Facility will submit proof that refund was issued by POC due date of June 9, 2026.

Type of visit: Office

An office meeting was conducted at 3:00pm on March 16, 2026, with Sacramento North Regional Office via Microsoft Teams. The purpose of this meeting was to discuss the facility's admission agreement. The following Licensing staff were present: Licensing Program Manager (LPM) Lauren Crocker and Licensing Program Analyst (LPA) Michael Hood The following facility representatives were present: Licensee Yenne Tezera The following topics were discussed during today's meeting: Admission Agreement: Refund policies in accordance with Title 22 Referral for Technical Support Program No deficiencies were cited. An exit interview was conducted and a copy of this report will be provided to the facility via email. A copy must be signed and returned to the Department.the state’s words, verbatim · CDSS document, Mar 16, 2026

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on March 11, 2026 to conduct a Post Licensing Inspection utilizing the inspection tool. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are six (6) bedrooms and five (5) bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 117 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on site. LPA observed knives, cleaning products, and other toxins to be locked away and inaccessible to residents. LPA observed the backyard and perimeter of the care home to be free of clutter and debris. LPA observed smoke detectors and carbon monoxide detectors to be operational in the care home. First aid kit is maintained and ready for emergency use. LPA reviewed two (2) residents' medications and observed medication storage to be locked away and inaccessible to the residents. LPA reviewed two (2) resident files and one (1) staff file. Facility has a current copy of certificate of liability insurance and LPA requested a copy. LPA also requested copies of the facility's emergency disaster plan and staff roster during visit. As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit was interview conducted and copy of report given at the conclusion of this visit.the state’s words, verbatim · CDSS document, Mar 11, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Michael Hood met with Licensee, Yenne Tezera, to conduct a Pre- Licensing visit. The facility has a fire clearance for six (6) ambulatory residents. Administrator Mark Murphy Ortiz has an active certificate (#6064330740 with expiration date February 20, 2026). LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are four (4) bedrooms and two (2) bathrooms for resident use. Bathrooms were in sanitary condition and properly maintained. LPA observed facility has the ability to prepare and store food, to lock away cleaning products and other toxins, and lock medications to make inaccessible to residents. LPA observed smoke detectors and carbon monoxide detectors at the care home to be operational. Component III was completed. LPA advised Licensee to obtain a thermometer for first aid kit and that hot water needs to be between 105 degrees F and 120 degrees F. Once Licensee provides information to LPA that they have obtained a thermometer and hot water is maintained between 105 degrees F and 120 degrees F, LPA will forward findings to the Centralized Application Bureau (CAB) for final review and approval. CAB will further contact applicant on final status of application. A copy of this report was provided to the facility. Exit interview conducted.the state’s words, verbatim · CDSS document, Sep 5, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: TEZERA, YENNE and ORTIZ, MARKMURPHY - Licensee and Administrator Interview Method: Telephone interview On 06/25/2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jun 25, 2025