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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515002741
Report Date: 08/07/2023
Date Signed: 08/07/2023 12:00:22 PM


Document Has Been Signed on 08/07/2023 12:00 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:WHITE ROCK SENIORS HOMEFACILITY NUMBER:
515002741
ADMINISTRATOR:NGICHU, LINDAFACILITY TYPE:
740
ADDRESS:490 WHITE ROCK DRIVETELEPHONE:
(916) 616-6464
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY:5CENSUS: 2DATE:
08/07/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Linda NgichuTIME COMPLETED:
11:45 AM
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This meeting was held via a phone call in response to Licensee/Administrator Linda Ngichu, reaching out last week to update Community Care Licensing Division on the status of the facility. Attending the meeting representing the facility was Licensee/Administrator Linda Ngichu. Representing Community Care Licensing Division was Licensing Program Manager Troy Ordonez, and Licensing Program Analyst (LPA) Kerry Hiratsuka.

Discussed was the closing procedures of a residential care facility for the elderly. Licensee inquired about the process last week.

No deficiencies cited.

This report was emailed to Licensee with the instructions to sign it and email a signed copy back to LPA.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2023
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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