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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201468
Report Date: 02/11/2025
Date Signed: 02/11/2025 01:56:32 PM

Document Has Been Signed on 02/11/2025 01:56 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:WHITEROCK, INC.FACILITY NUMBER:
079201468
ADMINISTRATOR/
DIRECTOR:
MENDOZA, ROLANDO GILFACILITY TYPE:
735
ADDRESS:3217 ALGER RDTELEPHONE:
(502) 457-8512
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY: 4CENSUS: 0DATE:
02/11/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Rolando Gil Mendoza, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:05 PM
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On 2/11/2025 at 12:45pm, Licensing Program Analyst (LPA) L. Hall conducted an announced pre-licensing inspection. LPA met with Rolando Gil Mendoza, Administrator, and explained the purpose of the visit. The facility has an approved fire safety clearance for one (1) ambulatory and three (3) non-ambulatory clients.

LPA inspected the facility inside and out including but not limited to the bedrooms, bathrooms, common living areas, kitchen, garage, back yard. The facility has a four (4) bedrooms and two (2) bathrooms. No bodies of water observed. There is sufficient lighting around the facility. Clients rooms are equipped with the proper furniture, bedding, and lighting. Bathrooms showers/tubs were equipped with non skid mats. Passageways and hallways are free of obstruction. Locked cabinets available to store medications, toxins and sharps. Hot water temperature is measured at 120.8 degrees Fahrenheit in shared clients' bathroom. Fire extinguisher was last serviced on 10/14/2024. There is a minimum of 7-day non-perishables and 2-day perishables foods. First Aid kit was complete. Carbon monoxide and smoke detectors present. Facility inspection matches the sketch that was provided.
  • Waiver of COMP III was approved by Licensing Program Manager H. Humpal.

No Issues were noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted with Administrator and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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