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Department of
SOCIAL SERVICES
Community Care Licensing
HOME CARE ORGANIZATION EVALUATION REPORT
Facility Number:
494700061
Report Date:
01/28/2026
Date Signed:
02/04/2026 11:39:50 AM
Document Has Been Signed on
02/04/2026 11:39 AM
- 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:
PROVIDENTIAL FIJIAN HOME CARE
FACILITY NUMBER:
494700061
ADMINISTRATOR/
DIRECTOR:
PITA TAUKEI
FACILITY TYPE:
300
ADDRESS:
884 THIRD ST, STE D
TELEPHONE:
(707) 239-8419
CITY:
SANTA ROSA
STATE:
CA
ZIP CODE:
95404
CAPACITY:
CENSUS:
DATE:
01/28/2026
Post Licensing
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
10:09 AM
MET WITH:
PITA TAUKEI
TIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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Enforcement Analyst (EA) Yolanda Hankerson conducted an enforcement visit and met with Pita Taukei for the purpose of inspection Post License visit. The visit included a review of Home Care Aide (HCA) personnel files and required license postings. The reviewed records and postings were found to be compliant. An exit interview was conducted at the conclusion of the visit. The Home Care Organization (HCO) was compliant and Mr. Pita Taukei was provided copies of Form 809 and Appeal Rights Form 508.
NAME OF LICENSING PROGRAM ANALYST:
Yolanda Hankerson
LICENSING PROGRAM ANALYST SIGNATURE:
DATE:
01/28/2026
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/28/2026
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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