392700527-4-17-2024-27-AS-KHOS-D4LMZU-20240423100344

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700527
Report Date: 04/15/2024
Date Signed: 04/17/2024 08:34:48 AM

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
04/10/2024 and conducted by Evaluator Avelina Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240410090152

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: 64	DATE:	04/15/2024
		UNANNOUNCED	TIME BEGAN:	09:24 AM
MET WITH:	Judy Rodriguez and Stephen Ratalift		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility does not provide adequate food to meet the residents’ needs

INVESTIGATION FINDINGS:

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On 04-15-2024 at 9:24 AM, Licensing Program Analyst (LPA) Avelina Martinez conducted an unannounced facility visit to open a complaint investigation with the above allegation. LPA Martinez met with Judy Rodriguez and Stephen Ratalift and explained the purpose of today's visit.

During today’s visit, LPA Martinez obtained facility records and conducted interviews. five out of five residents reported food is being served daily. In addition, two out of two kitchen staff reported residents are being served 3 meals per day. Staff also reported meal portions are adequate. LPA Martinez observed April 15, 2024 lunch meal. LPA Martinez observed the lunch meal portion to be adequate, and served to residents in the dinning room in a timely manner. Furthermore, LPA Martinez reviewed March and April 2024 food supply invoices. Food invoices indicated, an adequate food supply was being purchased and delivered to the facility regularly.

Continued...

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: 04/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

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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Control Number 27-AS-20240410090152

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: 04/15/2024

NARRATIVE

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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.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

LIC9099 (FAS) - (06/04)

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