392700527-8-24-2023-27-AS-KHOS-CVUKVN-20230920081435

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700527
Report Date: 08/24/2023
Date Signed: 08/24/2023 05:33:24 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
06/07/2023 and conducted by Evaluator Renee Campbell

COMPLAINT CONTROL NUMBER: 27-AS-20230607123919

FACILITY NAME:	BALANCE ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	392700527
ADMINISTRATOR:	RODRIGUES, JUDY		FACILITY TYPE:	740
ADDRESS:	1321 S FAIRMONT AVENUE		TELEPHONE:	(209) 334-3436
CITY:	LODI	STATE: CA	ZIP CODE:	95240
CAPACITY:	145	CENSUS: 64	DATE:	08/24/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Daisy Aguilar, Memory Care Director		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Residents are not being changed timely
Staff are not properly assisting residents with medication
Staff mismanaged resident's medication
Staff take the resident's pendants away
Staff are rough with residents in care

INVESTIGATION FINDINGS:

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On 08/24/2023, Licensing Program Analyst (LPA) Renee Campbell and LPA Victoria Brown arrived unannounced to conclude the investigation of the above mentioned allegations. LPA met with the Memory Care Director, Daisy Aguilar regarding the purpose of todays visit. LPA conducted interviews with staff, and residents during this visit.

Regarding allegation, "residents are not being changed timely", LPA interviewed residents R1 to R7 who did not concur with the allegation and confirmed that staff was available to help them. In addition, LPA obtained copies of the resident shower schedule and the hourly shift resident check list for June and August which indicates, all residents are being attended to on a regular basis for incontinence and showered on resident preferred days. LPA did not observe evidence that incontinence care is not being provided timely. During this visit, LPA's did not smell a foul odor in the facility and during a visit on 08/01/23, LPA Campbell did not smell a foul odor.

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: 08/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

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

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 27-AS-20230607123919

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 CARE	FACILITY NUMBER: 392700527
	VISIT DATE: 08/24/2023

NARRATIVE

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Regarding allegation," staff take the resident's pendants away", during interviews, LPA did not obtain evidence that this occurred. LPA tested pendants in two random rooms and staff arrived within one minute. There was not a preponderance of evidence to substantiate the allegation.

Regarding the allegation, "staff are rough with residents in care", during interviews with residents and staff, LPA did not obtain evidence that this occurred. There was not a preponderance of evidence to substantiate the allegation.

Based on all the information collected by the Department there is not a preponderance of evidence to prove the allegation occurred, therefore these allegation are 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 8, no deficiencies cited. Exit interview was held and a copy of report was given to Daisy Aguilar.

SUPERVISOR'S NAME: Emerita Curiel	TELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Renee Campbell	TELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
06/07/2023 and conducted by Evaluator Renee Campbell

COMPLAINT CONTROL NUMBER: 27-AS-20230607123919

FACILITY NAME:	BALANCE ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	392700527
ADMINISTRATOR:	RODRIGUES, JUDY		FACILITY TYPE:	740
ADDRESS:	1321 S FAIRMONT AVENUE		TELEPHONE:	(209) 334-3436
CITY:	LODI	STATE: CA	ZIP CODE:	95240
CAPACITY:	145	CENSUS: 64	DATE:	08/24/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Daisy Aguilar, Memory Care Director		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

1
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5
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7
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9

Staff do not offer alternatives meals to residents
Staff are not reporting resident falls

INVESTIGATION FINDINGS:

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3
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5
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On 08/24/2023, Licensing Program Analyst (LPA) Renee Campbell and LPA Victoriia Brown arrived unannounced to condiuct a complaint investigation on 08/24/23 to conclude the investigation of the above mentioned allegations. LPA met with the Memory Care Director, Daisy Aguilar regarding the purpose of todays visit. LPA conducted interviews with staff and residents during this visit.

Regarding the allegation, "Staff do not offer alternative meals to residents". During interviews, residents concur that alternative meals are available if they do not like what is prepared. LPA observed an alternative menu that is prepared and delivered to residents on a weekly basis.

Regarding allegation, "staff are not reporting resident falls". During todays visit, LPA interviewed residents R1 to R7, all of whom stated they had not had any recent falls or hospitalizations. However, during a file review, LPA observed that the facility is reporting incidents for June, July and August via email and or fax.

Unfounded

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: 08/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

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

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 27-AS-20230607123919

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 CARE	FACILITY NUMBER: 392700527
	VISIT DATE: 08/24/2023

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	The allegations are UNFOUNDED, meaning that the allegation was false, could not have happened and/or was without a reasonable basis. This Department has therefore dismissed the complaint. Per California Code of Regulations, no deficiencies were observed or cited. Exit interview held, and a copy provided.

SUPERVISOR'S NAME: Emerita Curiel	TELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Renee Campbell	TELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4