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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700527
Report Date: 08/01/2024
Date Signed: 08/15/2024 03:19:44 PM


Document Has Been Signed on 08/15/2024 03:19 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 CAREFACILITY NUMBER:
392700527
ADMINISTRATOR:AGUILAR, JONATHANFACILITY TYPE:
740
ADDRESS:1321 S FAIRMONT AVENUETELEPHONE:
(209) 334-3436
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:145CENSUS: 66DATE:
08/01/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jonathan AguilarTIME COMPLETED:
10:00 AM
NARRATIVE
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A Technical Support Program (TSP) engagement visit was conducted today on July 24, 2024 via Microsoft Teams with the Sacramento South Regional Office. Present at today's meeting include the following: Licensing Program Manager Liza King, and Licensing Program Analyst Avelina Martinez: Facility Representatives: Stephen Ratlift, Sharon Wong, and Josh Johnson, Christine Soriano, Shelly Chong; and Local Ombudsman: Kathryn Thomas,

The TSP process was explained during this meeting. In addition, TSP audit report findings were delivered during this Microsoft Teams meeting.

Topics discussed during the TSP Engagement Meeting:
  1. Record keeping
  2. Care & Supervision
  3. Medication Management
  • Facility representatives have implemented plans and procedures to support their compliance efforts.

Per California Code of Regulations (CCRs) - Title 22 no deficiencies are being cited at this visit. An exit interview was conducted with facility staff, and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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