392700527-3-7-2023-27-AS-LKIG-CPXPYZ-20230315114446

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700527
Report Date: 03/07/2023
Date Signed: 03/07/2023 03:23:30 PM

Unsubstantiated

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
12/30/2022 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20221230085211

FACILITY NAME:	BALANCE ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	392700527
ADMINISTRATOR:	MARLENE BREMER		FACILITY TYPE:	740
ADDRESS:	1321 S FAIRMONT AVENUE		TELEPHONE:	(209) 334-3436
CITY:	LODI	STATE: CA	ZIP CODE:	95240
CAPACITY:	145	CENSUS: 65	DATE:	03/07/2023
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Michele Fischer		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Staff are leaving resident unattended for an extended period of time.
Staff are not responding to requests for assistance in a timely manner.
Staff are not responding to requests for communication with resident's representative in a timely manner.
Facility does not have adequate lighting.

INVESTIGATION FINDINGS:

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On 3-7-23 at 1:15pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to continue complaint investigation and deliver findings for the allegations noted above. LPA met with facility manager Michele Fischer and explained the purpose of the visit. Administrator Melissa Orello was made aware of LPAs visit and gave permission for Michele to accommodate LPA and sign in her absence. During this investigation, LPA conducted a facility observation on 1-6-23 and 3-7-23. LPA also conducted interviews with Resident1 (R1), R2 and R3 and conducted additional interviews with various resident responsible parties. Additionally, staff conducted interviews with Staff1 (S1), S2, and S3.

Allegation #1: Staff are leaving resident unattended for an extended period of time. LPA conducted interviews with residents and responsible parties, and conducted facility observations as noted above. LPA observed facility staff to be attending to residents’ needs during observations conducted. Additionally, facility’s call system was functioning as normal during observations.
{Cont. on 9099C}

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

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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Control Number 27-AS-20221230085211

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: BALANCE ASSISTED LIVING AND MEMORY CARE	FACILITY NUMBER: 392700527
	VISIT DATE: 03/07/2023

NARRATIVE

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Based on interviews, there were no reports expressed of residents being left unattended for extended periods of time. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED

Allegation #2: Staff are not responding to requests for assistance in a timely manner. LPA conducted interviews with residents and responsible parties, and conducted facility observations as noted above. LPA observed staff on duty to be attending to resident needs within 5 minutes based on rounds conducted and signal system usage. Interviews conducted did not reveal lack of timely assistance when requested by residents in care. As a result, there is not a preponderance of evidence to conclude staff are not responding to requests for assistance in a timely manner, and this allegation is UNSUBSTANTIATED.

Allegation #3: Staff are not responding to requests for communication with resident’s representatives in a timely manner. LPA conducted interviews as noted above. Based on interviews conducted, it was determined that residents’ representatives have been contacted upon request and received responses from various departments including care giving and reception desk on same day or within 24 hours of requests. Additionally, based on interviews, it was undetermined if requests were made by specific residents’ responsible persons. As a result, there is not a preponderance of evidence to conclude staff not responding to request for communication with resident representatives, and this allegation is UNSUBSTANTIATED.

Allegation #4: Facility does not have adequate lighting. LPA conducted facility observations on 1-6-23 and 3-7-23. LPA observed lobby area of facility as well as all facility hallways and various resident rooms. Based on observations conducted as well as interviews with R1, R2, and R3, it was determined that adequate lighting exist throughout facility. LPA observed light bulbs to be functioning as normal during observation. As a result, there is not a preponderance of evidence to conclude that facility maintains inadequate lighting. Therefore, this allegation is UNSUBSTANTIATED.

An exit interview was conducted with Michele Fischer and a copy of this report was left with Michele. Appeal rights provided.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

LIC9099 (FAS) - (06/04)

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