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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 494700050
Report Date: 12/03/2024
Date Signed: 12/03/2024 04:10:03 PM

Document Has Been Signed on 12/03/2024 04:10 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:LOYAL FIJIAN, LLCFACILITY NUMBER:
494700050
ADMINISTRATOR/
DIRECTOR:		VENIANA VULAWALUFACILITY TYPE:
300
ADDRESS:78 CARLETON DR.TELEPHONE:
(707) 774-9186
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY: CENSUS: DATE:
12/03/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Licensee - Makereta HeresfordTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Home Care Services Branch (HCSB) Analyst, Todd Borcher, arrived at the business office of Loyal Fijian, LLC for a Two-Year Licensing inspection on December 3, 2024. Upon arrival, the Analyst identified himself and was greeted by licensee Makereta Heresford. The proper posting of business hours and license was observed. The Analyst was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review the Analyst discussed the findings of the inspection with the licensee and informed the licensee that no discrepancies were found. A copy of the report was provided with appeal rights. Exit interview was conducted.
LICENSING EVALUATOR NAME: Todd Borcher
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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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