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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700527
Report Date: 10/29/2024
Date Signed: 10/29/2024 04:38:16 PM

Document Has Been Signed on 10/29/2024 04:38 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/
DIRECTOR:
AGUILAR, JONATHANFACILITY TYPE:
740
ADDRESS:1321 S FAIRMONT AVENUETELEPHONE:
(209) 334-3436
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY: 145TOTAL ENROLLED CHILDREN: 0CENSUS: 64DATE:
10/29/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Jonathan AguilarTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 10/29/2024 at 1:15pm, Licensing Program Analyst (LPA Michael Bilger and Licensing Program Manager (LPM) Liza King conducted a case management visit regarding previous items in need of repair or replacement. LPA and LPM met with Administrator Jonathan Aguilar and explained the purpose of the visit. LPA and LPM toured facility grounds including dining room, various resident rooms, memory care unit, kitchen area, outside areas, and other common areas of facility. LPA reviewed list of items resulting from a previous LPA visit on 8/20/2024. LPA and LPM discussed with Administrator the following items to be addressed:

1. Missing sections of blinds in memory care needs to be replaced.
2. Completed construction was approved by City today 10/29/24. Areas required around completed construction require touch up paint
3. Video surveillance requires audio component to be removed
4. Dining room renovations including new staff break room is in process of being completed. Requires paint touch up, furniture, and completion of wall section.
5. Additional items left in memory care courtyard during recent construction to be removed.
6. Signal system is operational, but in process of being updated.
7. Memory care designated area for a social room requires additional furnishings for completion.

Other items noted from 8/20/2024 visit have been resolved.

Additionally, LPA and LPM observed all delayed egress doors to ensure functionality. Staff rooms for personal use are in process of being furnished and have been identified on the updated facility sketch. Air conditioning unit has been repaired and operating as normal. Facility is currently in pre-licensing process. LPA informed Administrator that above items must be completed prior to prelicensing approval.

No citations issued today. An exit interview was conducted with Administrator and a copy of this report was provided to Administrator.
Liza KingTELEPHONE: (650) 676-0442
Michael BilgerTELEPHONE: (916) 862-4722
DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
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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