392700527-3-29-2022-27-AS-KHOS-CD232L-20220330175206

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700527
Report Date: 03/25/2022
Date Signed: 03/29/2022 05:59:59 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/17/2021 and conducted by Evaluator Bruce Jacobs

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20211117144945

FACILITY NAME:	BALANCE ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	392700527
ADMINISTRATOR:	ORELLO, MELISSA		FACILITY TYPE:	740
ADDRESS:	1321 S FAIRMONT AVENUE		TELEPHONE:	(209) 334-3436
CITY:	LODI	STATE: CA	ZIP CODE:	95240
CAPACITY:	145	CENSUS: 60	DATE:	03/25/2022
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Daisy Aguliar, Administrator		TIME COMPLETED:	11:35 AM

ALLEGATION(S):

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Facility is in financial distress

Facility does not have telephone service

Facility failed to provide care to resident who have scabies

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bruce Jacobs arrived at the facility and met with Administrator Daisy Aguilar to deliver investigation findings on the above allegations. This investigation consisted of site inspections to the facility to conduct inspections and interviews with the facility administrator, staff and residents. This complaint was also referred to the Audits Unit and a audit was conducted on the facility's finances.

The financial audit determined that the facility had adequate financial assets and operational income and the facility is not in financial distress. The facility had one day of localized telephone and internet outage related to the service provider and not related to facility. The facility did admit 4 residents from another facility who arrived to the care home with scabies. The facility treated the residents upon arrival and cleared the residents of the condition.

As a result of this investigation, LPA finds the allegations to be without a reasonable basis and therefore the allegations are determined to be UNFOUNDED.

Exit interview conducted and report provided. Appeals rights printed.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Bruce Jacobs	TELEPHONE: (916) 956-5861
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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