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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700527
Report Date: 03/27/2023
Date Signed: 03/27/2023 03:54:31 PM


Document Has Been Signed on 03/27/2023 03:54 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:BALANCE ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
392700527
ADMINISTRATOR:MELISSA ORELLOFACILITY TYPE:
740
ADDRESS:1321 S FAIRMONT AVENUETELEPHONE:
(209) 334-3436
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:145CENSUS: 66DATE:
03/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Melissa Orello. DirectorTIME COMPLETED:
04:00 PM
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On 03/27/2023 at 9:00 am, Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to conduct a required 1-year annual inspection. LPA met with Administrator, Melissa Orello and explained the purpose of today’s inspection. LPA was allowed entry into the facility that is licensed to serve a total capacity of 145 non-ambulatory residents of which 20 may be on hospice. There are currently 66 clients in residence and 45 on staff.

LPA toured the facility including but not limited to apartments, bathrooms, kitchen, common area, and courtyard. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 71 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ bathrooms was measured at 111, and 114 degrees Fahrenheit. There is a minimum of 7-day supply of nonperishable and 2-day of perishable foods. LPA observed smoke detector is interconnected with the fire department. Fire extinguisher was last serviced on September 26, 2022. LPA observed mitigation plan is complete.

LPA observed one refrigerator was not working as of today and awaiting repair.
There were two other refrigerators that were functioning at 38 degrees Fahrenheit that the facility continued to use.

No deficiencies were cited during this inspection. Exit interview conducted. Appeal Rights and a copy of this report provided.
SUPERVISOR'S NAME: Emerita CurielTELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2023
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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