392700527-9-13-2023-27-AS-KHOS-CVUKVM-20230920081435

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700527
Report Date: 09/13/2023
Date Signed: 09/13/2023 05:57:16 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:	09/13/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Judy Rodrigues, Executive Director		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Staff are not properly assisting residents with medication
Staff mismanaged resident's medication

INVESTIGATION FINDINGS:

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On 09/13/23 at 8:30 am, LPAs Campbell and Victoria Brown arrived unannounced to complete a complaint investigation. Upon further review, LPA's are revising the complaint, as allegations were not addressed on the prior report of 08/24/23. Upon arrival, LPA's met with Daisy Aguilar, Memory Care Director and Judy Rodrigues, Executive Director and stated the purpose of the visit. In regards to the allegation, that “Staff are not properly assisting residents with medication, this allegation is referring to staff possibly plugging noses and tipping heads and administering medications in apple sauce. S2 and S5 indicated during interviews that R12 has a prescription for crushed medication. During interviews with S6, LPA obtained information that no staff were observed pinching residents’ noses or tipping their heads back, forcing them to take medication.Based on interviews, LPA's observed the peponderance has not been met.

In regard to the allegation, “Staff mismanaged resident's medication”, this allegation is referring to R8 who was possibly given insulin without first checking their blood sugar.
S2 and S3 both indicated that staff are not allowed to administer insulin or finger pricks.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Emerita Curiel	TELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Renee Campbell	TELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

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-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: 09/13/2023

NARRATIVE

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However, staff stated they are trained to assist residents with preparation for self administration.
During interviews with S5, it was stated that staff are not trained to give out medication or administer insulin as it is not part of the job description. S2, S5 and S6 reported that they had not observed other staff tipping residents head back or plug resident's nose to dispense medication. LPA's observed the preponderance has not been met.

These two allegations were deemed unsubstantiated from the previous complaint report dated 08/24/23. These two allegations will remain with the same finding of unsubstantiated.

Per California Code of Regulations (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: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

LIC9099 (FAS) - (06/04)

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