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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 02:43:08 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
02/29/2024 and conducted by Evaluator Avelina Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240229092629

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:
08:30 AM
MET WITH:Daisy Aguilar and Judy Rodriquez TIME COMPLETED:
02:42 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff does not keep facility free from odor.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 02-29-2024 at 8:00 AM, Licensing Program Analyst (LPA) Avelina Martinez and Licensing Program Manger (LPM) Liza King conducted an unannounced facility visit to open a complaint investigation with the above allegation. LPA Martinez met with Daisy Aguilar and Judy Rodriquez and explained the purpose of today's visit.

During today’s visit, LPA and LPM conducted file reviews, toured the facility, and conducted a medication room audit. During today's visit, LPM King smelled a foul urine odor in the memory care unit. Facility staff informed LPM King that the facility is in the process of deep cleaning the facility carpets. The facility was cited under complaint 27-AS-20240105135347 on 02/29/2024. Therefore, this allegation is substantiated and the deficiency and plan of correction can be found under complaint number 27-AS-20240105135347; 9099 reported dated 02/29/2024. As a result of this investigation, the Department finds this allegation to be Substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted, and a copy of this report was provided to facility.
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)
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