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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 494700034
Report Date: 03/24/2026
Date Signed: 03/24/2026 03:54:48 PM

Document Has Been Signed on 03/24/2026 03:54 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:DIVINE FIJIAN'S HOME CAREFACILITY NUMBER:
494700034
ADMINISTRATOR/
DIRECTOR:
KOROITAMANA, POASAFACILITY TYPE:
300
ADDRESS:3270 MENDOCINO AVETELEPHONE:
(707) 304-9179
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY: CENSUS: DATE:
03/24/2026
OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:05 PM
MET WITH:Poasa KoriotamanaTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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Enforcement Analyst (EA) Yolanda Hankerson contacted the licensee Poasa Koriotamana and Sanaila Seru via telephone 707-304-9179 and 707-843-5663 and successfully spoke with the licensee.
The EA introduced themselves and explained their role with the Home Care Services Branch (HCSB). The purpose of the call was to discuss and schedule an upcoming required licensing visit. The option of conducting the visit virtually was presented and discussed in detail.
During the conversation, EA reviewed the virtual visit process, including the technology requirements, expectations for participation, and the ability to meet all applicable licensing requirements remotely. The expectations for file review were explained, including the requirement that all records be complete, accessible, legible, and available for review at the time of the visit. Licensing requirements and attendance expectations were also discussed.
The licensee confirmed the ability to meet the virtual visit requirements and agreed that a virtual visit would be an appropriate option. Both parties agreed to the meeting format and scheduled April 30, 2026 at 11:00am. The licensee acknowledged understanding of the expectations and requirements.
NAME OF LICENSING PROGRAM ANALYST: Yolanda Hankerson
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
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