392700527-3-6-2024-27-AS-KHOS-D39RA3-20240311125029

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700527
Report Date: 03/06/2024
Date Signed: 03/06/2024 04:24:57 PM

Unsubstantiated

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
02/05/2024 and conducted by Evaluator Avelina Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240205113239

FACILITY NAME:	BALANCE ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	392700527
ADMINISTRATOR:	RODRIGUEZ, 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:	03/06/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Judy Rodriguez and Daisy Aguilar and Stephen Ratlift		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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9

Staff are threatening residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Avelina Martinez arrived at the facility unannounced on 03/06/2024 at 9:00 AM to follow up on a complaint and 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, LPA Martinez conducted interviews, toured the facility, and reviewed facility records. LPA Martinez interviewed resident 1 (R1) and resident 2 (R2). Both residents reported they have not witnessed facility staff threaten residents. In addition, R1 and R2 reported they have not experienced threats from facility staff.

Due to the above noted information, although the allegations 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.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

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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