<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700527
Report Date: 04/22/2024
Date Signed: 04/22/2024 12:28:37 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
03/22/2024 and conducted by Evaluator Avelina Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240322170617
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: 64DATE:
04/22/2024
UNANNOUNCEDTIME BEGAN:
10:19 AM
MET WITH:Stephen Ratlift and Christine SorianoTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are mismanaging residents medication.
Administrator is not of good character.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04-22-2024 at 9:00 AM, Licensing Program Analyst (LPA) Avelina Martinez conducted an unannounced facility visit to deliver complaint investigation findings. LPA Martinez met with Stephen Ratlift and Christine Soriano and explained the purpose of today's visit.

Throughout the course of the investigation, LPA Martinez conducted interviews and reviewed facility records. It was learned resident 1's (R1) controlled medication bottle was given to resident 2 (R2) in error. Furthermore, R2 ingested five pills from R1's medication bottle. Additionally, the complaint investigation has revealed, the facility Administrator's behavior towards facility staff, responsible parties, and community agencies' staff has been non-professional, demeaning, and in aggressive manner. Based on complaint interviews, the preponderance of evidence was met.

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: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024
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 4
Control Number 27-AS-20240322170617
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: 04/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/03/2024
Section Cited
CCR
87465(a)(4)
1
2
3
4
5
6
7
87465(a)(4) Incidental Medical and Dental Care: A plan for incidental medical and dental care shall be developed by each facility...The licensee shall assist residents with self administered medications as needed. This requirement was met as evidence by: Based on file reviews and interviews...
1
2
3
4
5
6
7
the Facility has implemented medication delivery policy. In addition, the facility agrees to conduct a medication training for all care staff and Med-techs, and front receptionist by a medication training vendor/company by POC Date 05/03/2024.
8
9
10
11
12
13
14
the Licensee did not ensure R1's controlled medication was safeguarded and did not ensure R1 and R2 were assisted with medications as needed. This posed an immediate health and safety risk to R1 and R2.
8
9
10
11
12
13
14
Training documents should be emailed to LPA Martinez by POC date 05/03/2024 5:00 PM.
Type B
05/06/2024
Section Cited
CCR
87405(d)(5)
1
2
3
4
5
6
7
87405(d)(5) Administrator - Qualifications and Duties...The administrator of a facility or facilities shall have the responsibility and authority to carry out the policies of the licensee...Good character and a continuing reputation of personal integrity. This requirement was not met as evidence by
1
2
3
4
5
6
7
Facility staff agrees to conduct management and team/leadership building training plan by POC Date 05/06/2024. Facility staff agrees to email LPA Martinez when training has been completed.
8
9
10
11
12
13
14
Based on interviews, the Licensee did not ensure the Administrator was engaging in a positive and or professional manner with staff, responsible parties, community agencies. This posed a potential health and safety risk to residents in care.
8
9
10
11
12
13
14
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: 04/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 27-AS-20240322170617
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: 04/22/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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. 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: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4