<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 494700050
Report Date: 06/24/2026
Date Signed: 06/24/2026 03:56:06 PM

Document Has Been Signed on 06/24/2026 03:56 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:
06/24/2026
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Makereta LeduaTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Enforcement Analyst (EA) Yolanda Hankerson conducted a Biennial virtual visit and met with the designee,Veniana Vulawalu Makereta Ledua. During the visit, EA verified the posting of the license, observed the operation of the business, confirmed compliance with insurance requirements, and completed the required personnel file review.

The Home Care Organization (HCO) was found not to be in compliance with applicable sections of the Health and Safety Code (HSC). Deficiencies were cited and documented on the 809D Correction Report. The deficiencies were discussed with the licensee/designee at the time of the visit.

An exit interview was conducted, and copies of the 809 Facility Evaluation, 809 Deficiencies, 859 Staff Records Review Reports, and appeal rights information were provided via email.
NAME OF LICENSING PROGRAM ANALYST: Yolanda Hankerson
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 06/24/2026 03:56 PM - It Cannot Be Edited


Created By: Yolanda Hankerson On 06/24/2026 at 01:01 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
Although this visit/inspection may have focused on the review of specific licensing requirements, the applicant/licensee must comply with all applicable requirements. The California Department of Social Services retains authority to issue citations or take disciplinary action for any deficiency.


FACILITY NAME: LOYAL FIJIAN, LLC
FACILITY NUMBER: 494700050

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/06/2026
Section Cited
1796.43 (a)
1
2
3
4
5
6
7
Home care organizations that employ affiliated home care aides shall ensure the affiliated home care aides are cleared on the home care aide registry before placing the individual in direct contact with clients. Proof of clearance on the Home Care Aide
8
9
10
11
12
13
14
Registry was not documented in #1 and #2 of the caregiver’s personnel records that were reviewed by HCSB analyst. This poses an immediate health and safety risk to clients in care.
8
9
10
11
12
13
14
Type A
07/06/2026
Section Cited
1796.23 (a)
1
2
3
4
5
6
7
Each person initiating a background examination to be a registered home care aide shall submit his or her fingerprints to the Department of Justice by electronic transmission in a manner approved by the
8
9
10
11
12
13
14
department, unless exempt under subdivision (d). Criminal Background Clearance and/or Exemption approval was not obtained for INDICATE_NUMBER of the caregivers on staff. This poses an immediate health and safety risk to clients in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
LICENSING EVALUATOR NAME: Yolanda Hankerson
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2026
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 06/24/2026 03:56 PM - It Cannot Be Edited


Created By: Yolanda Hankerson On 06/24/2026 at 01:11 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
Although this visit/inspection may have focused on the review of specific licensing requirements, the applicant/licensee must comply with all applicable requirements. The California Department of Social Services retains authority to issue citations or take disciplinary action for any deficiency.


FACILITY NAME: LOYAL FIJIAN, LLC
FACILITY NUMBER: 494700050

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/06/2026
Section Cited
1796.45 (a)
1
2
3
4
5
6
7
 Affiliated home care aides hired on or after January 1, 2016, shall submit to an examination 90 days prior to employment, or within seven days after employment, to determine that the individual is free of active tuberculosis disease.
8
9
10
11
12
13
14
TB clearance was not documented in INDICATE_NUMBER of the caregiver’s personnel records that were reviewed by HCSB analyst. This poses an immediate health and safety risk to clients in care.
8
9
10
11
12
13
14
Type B
07/22/2026
Section Cited
1796.42
1
2
3
4
5
6
7
A home care organization licensee shall do all of the following:(b) Maintain and abide by a valid workers’ compensation policy covering its affiliated home care aides. (c) Maintain and abide by an employee dishonesty bond, including third-party coverage, with a minimum limit of ten thousand dollars ($10,000).
8
9
10
11
12
13
14
(d) Maintain proof of general and professional liability insurance in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the aggregate.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
LICENSING EVALUATOR NAME: Yolanda Hankerson
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2026
LIC809 (FAS) - (06/04)
Page: 3 of 3