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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700527
Report Date: 07/28/2023
Date Signed: 08/01/2023 08:35:23 AM


Document Has Been Signed on 08/01/2023 08:35 AM - 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:RODRIGUES, JUDYFACILITY TYPE:
740
ADDRESS:1321 S FAIRMONT AVENUETELEPHONE:
(209) 334-3436
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:145CENSUS: 59DATE:
07/28/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Chris Schuster, VP of OperationsTIME COMPLETED:
05:30 PM
NARRATIVE
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On 07/28/23, Licensing Program Analyst (LPA) Renee Campbell and LPA Aveline Martinez arrived unannounced to conduct a case management. Upon entering the facility, LPA Campbell observed a common area near the entrance. Unopened packages were sitting near the receptionists desk. Chairs and couches were arranged into a conversation area in the middle of the room. An unfinished construction area surrounded in plastic that came up five feet was to the left. No residents were present in the common area upon entry but they later arrived to sit on the couches 40 minutes before dinner at 4:30 pm.

Community Care LIcensing (CCL) was notified of possible ongoing construction without a permit. LPA Campbell and LPA Martinez met with Chris Schuster, VP of Operations who arrived about 15 minutes after the LPA's arrived. LPA then conducted a random survey of residents rooms in the facility during a tour of the facility. Of the 15 residents rooms assessed, none had inoperable sliding glass doors or windows. Of the 15 residents asked, 15 stated they had no issues with their sliding glass doors or windows. LPA There were no changes to the inside of the facility. LPA Campbell also toured the outside of the facility. There were two construction trash bins that had been present during a prior visit on 07/28/23 and a room was open to the elements due to the stop construction order. By my observations, no new construction has been done.

While touring the outside of the facility, the following building and maintenance issues were found:
  • Tripping hazards found with 2 water hoses by resident patio walkway
  • Construction debris consisting of nails, screws and electric socket plates were found in outside common areas.
  • No screens were found on some windows and sliding glass doors
  • Pests were found in a residents entrance by the sliding glass doors that had no screens
The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct deficiencies may result in civil penalties.
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: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 08/01/2023 08:35 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
08/11/2023
Section Cited
CCR
87303(a)

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Maintenance and Operation: The facility shall be... safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance ... for the safety and well-being of residents, employees and visitors. This requirement is not met at evidenced by:
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LIcensee will complete all repairs by POC date. POC will be clearedd by LPA visit.
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Based on observation and interview, the licensee did not keep the facility in good repair and tripping hazards were found in resident common patio areas. This posed a potential hazard risk for residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Emerita CurielTELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:
DATE: 07/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2023
LIC809 (FAS) - (06/04)
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