392700527-5-12-2023-27-AS-KHOS-CSUJRP-20230616071701

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700527
Report Date: 05/12/2023
Date Signed: 05/12/2023 03:10:11 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
04/24/2023 and conducted by Evaluator Renee Campbell

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230424074505

FACILITY NAME:	BALANCE ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	392700527
ADMINISTRATOR:	MELISSA ORELLO		FACILITY TYPE:	740
ADDRESS:	1321 S FAIRMONT AVENUE		TELEPHONE:	(209) 334-3436
CITY:	LODI	STATE: CA	ZIP CODE:	95240
CAPACITY:	145	CENSUS: 65	DATE:	05/12/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Meghan Moore, Culinary Director		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility staff are stealing money from residents.

INVESTIGATION FINDINGS:

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On 05/11/23, Licensing Program Analyst (LPA) Renee Campbell made an unannounced complaint visit to this facility at approximately 1:00 pm. LPA Campbell was met by Megan Moore, Culinary Director and explained the reason for the visit.

Based on interviews, LPA Renee Campbell established with the complainant that no money had been stolen from her. However, she had been missing two nightgowns since approximately the last year. R1 could not remember the name of the person she suspected of having taken them and she stated that the staff member no longer worked for the faciity. LPA Renee Campbell interviewed other residents for other possible incidents of theft and none were reported.

Based on all the information collected by the Department there is not a preponderance of evidence to prove the allegation occurred, therefore this allegation is UNSUBSTANTIATED. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore this allegation is unsubstantiated. Per California Code of Regulations (CCRs) - Title 22, Division 6, no deficiencies cited. Exit interview was held and a copy of report was given to Megan Moore. Appeal rights provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Emerita Curiel	TELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Renee Campbell	TELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

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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