392700527-8-31-2023-27-AS-KHOS-CVUL53-20230920082628

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700527
Report Date: 08/31/2023
Date Signed: 08/31/2023 04:23:02 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
07/06/2023 and conducted by Evaluator Renee Campbell

COMPLAINT CONTROL NUMBER: 27-AS-20230706140806

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: 63	DATE:	08/31/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Daisy Aguilar, Memory Care Director		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff do not provide adequate supervision to residents in care.
Staff do not provide adequate food service.
Staff do not provide adequate laundry service.
Staff not cleaning facility.
Staff not meeting residents’ hygiene needs.
Facility in disrepair.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Renee Campbell and LPA Victoria Brown arrived unannounced on 08/31/2023 at 08:30 am to further investigate the above mentioned allegations. LPA met with Judy Rodrigues, Administrator and Daisy Aguilar, Memory Care Director and stated the purpose of the visit. LPA reviewed interviews and facility records during this visit.

In regards to staff not providing adequate supervision to residents in care, LPA obtained information through interviews that additional staff may be needed. LPA observed the facility notes that indicated on 06/16/23, R7 AWOL’d but was found on the premises of the facility. The facility had no knowledge or documentation that R8 AWOL’d anytime during the month of June. R7 and R8 were mentioned as being AWOL. However, the residents were on the premises.

In regards to staff not providing adequate food service. LPA interviewed residents R1 to R7 who reported that they liked the food and that they were aware that they could select alternative meals. Menus were provided for review of both basic and alternative meal service. None of the residents interviewed reported a dissatisfaction with the food service.

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: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

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-20230706140806

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: 08/31/2023

NARRATIVE

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In regards to staff not providing adequate laundry service, residents R1 to R7 reported that laundry was completed and returned quickly. Staff reported that there were 2 washing machines and three dryers just for the Assisted Living area and there were 2 washers and 2 dryers for memory care. Laundry is completed over night and quickly returned to residents.

In regards to staff not cleaning facility, residents R1 to R7 were interviewed and reported no issues with the quality of cleaning. Staff also reported that carpets are spot cleaned by an independent service provider.

In regards to staff not meeting residents’ hygiene needs, R1 to R7 have reported that they have received the necessary items to maintain their hygiene from the facility or purchased their preferred products themselves. LPA obtained a copy of the shower schedule, based on the preferred days from each resident.

In regards to the facility in disrepair, staff reported that the dining room floor will be replaced. Staff also indicated that the carpet had been replaced approximately 2 years ago. The facility hired a private contractor for maintenance service of the physical plant who confirmed during interviews today that the carpet is spot cleaned weekly. In addition, the facility is undergoing major renovations.

The investigation revealed the preponderance of evidence standards has not been met; therefore, the above allegation(s) is found to be UNSUBSTANTIATED. A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Per CCR (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. An exit interview was conducted, and a copy of this report was provided.

SUPERVISOR'S NAME: Emerita Curiel	TELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Renee Campbell	TELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC9099 (FAS) - (06/04)

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