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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202507
Report Date: 08/06/2024
Date Signed: 08/07/2024 10:46:04 AM


Document Has Been Signed on 08/07/2024 10:46 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:BALANCE RESIDENTIAL CARE CORPORATIONFACILITY NUMBER:
157202507
ADMINISTRATOR:BICERA, VICTORIAFACILITY TYPE:
740
ADDRESS:9802 VERTRICE AVE.TELEPHONE:
(661) 665-0535
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:6CENSUS: 4DATE:
08/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Administrator Victoria Bicera and Staff Linda NatividadTIME COMPLETED:
02:00 PM
NARRATIVE
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On 08/06/24 Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual
Inspection. LPA introduced self, stated the purpose of the visit, and was greet by staff Linda Natividad. Administrator Victoria Bicera was called and arrived later during inspection. Three residents were present during inspection.

LPA toured facility with staff. Residents were observed in the common area. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. Freezer temperature was maintained at -2 degrees F and refrigerator temperature was maintained at 40 degrees F. Cleaning chemicals was observed stored and locked under kitchen sink. Fire extinguisher was observed with a purchased date of 4/29/24. Washer was observed operational during visit. Tools, toolbox, and chemical cabinet observed unlock in the garage. Extra linens observed. Residents' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured. Hot water temperature was tested range between 105.2 in bathroom. Outside of facility toured. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for residents. Medications were checked and observed kept locked in kitchen shelves. Residents’ MARS was reviewed, and medication were audit. All residents’ file and all staff files were reviewed.



A deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22,
Division 6.

Exit Interview conducted. The following documents requested to be updated and submitted to Fresno CCL by 08/12/24: Lic 308, Lic 500, Lic 610E, current liability insurance, and control of property. A copy of this report and appeal rights provided to Administrator, whose signature confirms receipt of this report.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2024
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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Document Has Been Signed on 08/07/2024 10:46 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710


FACILITY NAME: BALANCE RESIDENTIAL CARE CORPORATION
FACILITY NUMBER: 157202507

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87465(c)(2)
87465 (c)(2) Once ordered by the physician the medication is given according to the physician's directions.

This requirement was not met as evidenced by:
Deficient Practice Statement
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Based on interviews, records review, and observation, staff did not administered R1’s medication Hydralazine as directed by physician, which poses an immediate health and safety risk for the person in care
POC Due Date: 08/07/2024
Plan of Correction
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Licensee shall have staff be retrained on administering medications. Licensee will submit documentation of training topics with staff attendance rooster to the Fresno CCL office by 08/07/24.
Type A
Section Cited
CCR
87309(a)
87309(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above when LPA observed at 09:15AM, cleaning chemicals stored in garage cabinet with thin chain with a small padlock was observed not locked and latched. Tools and a toolbox were observed stored on garage shelf unlock. At 09:27AM, a tree pruner and shovel were observed against wall on the side of the facility accessible to residents in care this poses an immediate health, safety or personal rights risk to persons in care
POC Due Date: 08/07/2024
Plan of Correction
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Staff immediately removed the tools and toolbox into the garage cabinet and lock the padlock. Staff removed the sharp on the tree pruner and threw the shovel away in the trash can. POC cleared during visit.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 08/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 08/07/2024 10:46 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710


FACILITY NAME: BALANCE RESIDENTIAL CARE CORPORATION
FACILITY NUMBER: 157202507

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87468.1(a)(2)
87468.1(a)(2) Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above when a camera with audio was installed in bedroom 2 and in the family room which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/07/2024
Plan of Correction
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The audio camera was removed during visit. POC cleared during visit.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 08/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3