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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700527
Report Date: 10/01/2024
Date Signed: 10/01/2024 04:31:28 PM


Document Has Been Signed on 10/01/2024 04:31 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:BALANCE ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
392700527
ADMINISTRATOR:AGUILAR, JONATHANFACILITY TYPE:
740
ADDRESS:1321 S FAIRMONT AVENUETELEPHONE:
(209) 334-3436
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:145CENSUS: 62DATE:
10/01/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Jonathan AguilarTIME COMPLETED:
04:45 PM
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On 10-1-2024 at 1:15pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a quarterly compliance case management. LPA met with Administrator Jonathan Aguilar and explained the purpose of the visit. LPA observed facility to be clean and sanitary throughout with no foul odors or excessive stains on floors or walls. Current census is 62 with 5 caregivers and 2 med techs on duty. Additionally, facility hired one activities director on 8-27-2024, and currently has two activity assistance who are also trained to perform care giving duties as needed. Kitchen staff consists of three cooks, and two kitchen aides. Facility has adequate food supply in place and current temperature is comfortable at 73*F.

During today's visit, LPA reviewed weekly medication audits conducted by facility, most recent medication plan, medication log sheets, weekly work schedule, needs and service plans audits, and activity plan. Pharmacy audits are continuing quarterly. Ten hours of medication training has been completed and continues as necessary for applicable facility staff. LPA reviewed updated LIC 500 which reflects Administrator presence of at least 40 hours per week. Facility continues to employ licensed nurse on duty full time.

During facility tour, LPA observed adequate amount of incontinence and other supplies available for residents in care. Facility has a current system for ordering supplies to ensure on-going adequate amounts. Facility is currently preparing for a pre-licensing visit due to change of ownership. Licensing Department will continue to conduct quarterly visits. Facility utilized technical support services in July 2024 to aid in on-going compliance.

No citations issued today. An exit interview was conducted with Administrator and a copy of this report was provided to Administrator.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: (916) 862-4722
LICENSING EVALUATOR SIGNATURE:
DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/01/2024
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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