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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700527
Report Date: 02/29/2024
Date Signed: 02/29/2024 05:29:08 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/22/2024 and conducted by Evaluator Avelina Martinez
COMPLAINT CONTROL NUMBER: 27-AS-20240222155121
FACILITY NAME:BALANCE ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
392700527
ADMINISTRATOR:RODRIGUEZ, JUDYFACILITY TYPE:
740
ADDRESS:1321 S FAIRMONT AVENUETELEPHONE:
(209) 334-3436
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:145CENSUS: 63DATE:
02/29/2024
UNANNOUNCEDTIME BEGAN:
02:46 PM
MET WITH:Judy Rodriguez and Daisy Aguilar and Stephen RatliftTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Facility staff are not properly cleaning facility kitchen.
Facility staff are not following a scheduled menu.
Facility staff do not meet residents' dietary needs.
Facility staff do not provide adequate food service to residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Avelina Martinez and Licensing Program Manager (LPM) Liza King arrived at the facility unannounced on 02/29/2024 at 8:00 AM to deliver complaint findings, LPA Martinez met with Judy Rodriguez and Daisy Aguilar and Stephen Ratlift and explained the purpose of the visit.

Throughout the course of the investigation, LPM King and LPA Martinez conducted interviews, toured the facility, and reviewed facility records. During today's kitchen tour, the kitchen was not sanitary. The following was observed: dirty water in mop bucket, food particles on the floor, and garbage debris/dirt under sink. Additionally, kitchen sink hot water faucet is not in good repair. Moreover, the facility began implementing a meal menu in February 2024. The first meal menu provided to residents in care was in February 2024 for March 2024. LPM King observed breakfast service today. Residents were served eggs, toast, and oatmeal. No fruit or meat was provided during today's breakfast meal. Additionally, meals were severed in Styrofoam containers, which did not keep the food warm, and did not the protect safety, acceptability and nutritive values of food being served. Continued...
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/22/2024 and conducted by Evaluator Avelina Martinez
COMPLAINT CONTROL NUMBER: 27-AS-20240222155121

FACILITY NAME:BALANCE ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
392700527
ADMINISTRATOR:RODRIGUEZ, JUDYFACILITY TYPE:
740
ADDRESS:1321 S FAIRMONT AVENUETELEPHONE:
(209) 334-3436
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:145CENSUS: 63DATE:
02/29/2024
UNANNOUNCEDTIME BEGAN:
02:46 PM
MET WITH:Judy Rodriguez and Daisy AguilarTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Facility staff are not properly addressing pest infestation in facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Avelina Martinez and Licensing Program Manager (LPM) Liza King arrived at the facility unannounced on 02/29/2024 at 8:00 AM to deliver complaint findings, LPA Martinez met with Judy Rodriguez and Daisy Aguilar and explained the purpose of the visit.

Throughout the course of the investigation, LPM King and LPA Martinez conducted interviews, toured the facility, and reviewed facility records. During today's kitchen tour, the kitchen was not sanitary. However, no pest were found in the kitchen during today's inspection. Furthermore, facility kitchen staff reported there are no pest in the kitchen and dinning area. 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 did or did not occur, and therefore the allegation is unsubstantiated.

An exit interview was conducted, and a copy of this report was provided to the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024
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 5
Control Number 27-AS-20240222155121
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BALANCE ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 392700527
VISIT DATE: 02/29/2024
NARRATIVE
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There are no mechanism or procedures in place to maintain food temperatures. At 8:47 AM, LPM King observed room service being provided to resident 1. At 9:13 AM, resident was not fed by care staff, and LPM King assisted resident 1 with drinking water and assisted with feeding resident 1.

As a result of this investigation, the Department finds these allegations to be Substantiated. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations.

An exit interview was conducted, and a copy of this report was provided to the facility.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20240222155121
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BALANCE ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 392700527
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2024
Section Cited
CCR
87303(a)
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87303(a) Maintenance and Operation: The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidence by: Based on observation and inspection: the following was observed dirty water in mop bucket, food particles on the floor, garbage debris
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Facility staff agrees to: conduct maintenance and operation training for all kitchen staff by 03/06/24. Training materials shall be emailed to LPA 03/06/24 by 5:00 PM
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under kitchen sink. This posed an posed a potential health and safety risk to residents in care.
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Type B
02/29/2024
Section Cited
CCR
87555(b)(6)
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87555(b)(6) General Food Service Requirements: The following food service requirements shall apply:In facilities for sixteen (16) persons or more, menus shall be written at least one week in advance and copies of the menus as served shall be dated and kept on file for at least 30 days...
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Facility staff has implemented menus and provided menus to residents in care in Feb 2024. POC cleared at visit.
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Menus shall be made available for review by the residents...This requirement was not met as evidence by: Based on interviews, and observation. The facility started creating menus in Feb 24, and the first menu provided to residents was in Feb 24 for March 24. This posed a potential health and safety risk to 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: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 02/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20240222155121
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BALANCE ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 392700527
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2024
Section Cited
CCR
87555(b)(9)
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87555(b)(9) General Food Service Requirements: Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. This requirement was not met as evidence by:
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Facility staff agreed to implement hot box containers for meal service by POC date 03/06/24. Hot box is goint to beimplemented on 03/01/24. Facility staff agrees to submit hot box procedures by poc date 03/06/24 5:00 PM.
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Based on observation, interviews, and inspection, the Licensee did not ensure resident 1's food was protected for nutritious values due to serving food in styrofoam containers. This posed an potential health and safety risk to R1.
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Type B
03/06/2024
Section Cited
CCR
87555(b)(a)
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87555(b)(a) General Food Service Requirements: The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council.
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Facility staff agrees to conduct General Food Service Requirements for all kitchen staff by POC date 03/06/24 by 5 PM. All training materials should be emailed to LPA Martinez
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This requirement was not met as evidence by: Based on observation: the Licensee did not ensure residents were being provided the recommended dietary allowances of the food and nutrition. Fruit was not served during breakfast. This posed an potential health and safety risk to 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: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 02/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5