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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700527
Report Date: 07/12/2024
Date Signed: 07/12/2024 04:23:04 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
07/08/2024 and conducted by Evaluator Avelina Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240708164104
FACILITY NAME:BALANCE ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
392700527
ADMINISTRATOR:BREMER, MERLENEFACILITY TYPE:
740
ADDRESS:1321 S FAIRMONT AVENUETELEPHONE:
(209) 334-3436
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:145CENSUS: 69DATE:
07/12/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Marlene Bremer and Stephen Ratlift TIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility staff do not provide adequate food service to residents.
Facility is not providing daily activities for residents in care.
Facility air conditioner is not in good repair.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Avelina Martinez arrived at the facility unannounced on 07/12/2024 at 9:00 AM to deliver complaint findings, LPA Martinez met with Marlene Bremer and Stephen Ratlift and explained the purpose of the visit.

Throughout the course of the investigation, LPA Martinez conducted interviews, toured the facility, reviewed facility records. LPA Martinez conducted facility visits on July 11, 2024 and July 12, 2024. LPA Martinez observed there were no activities provided on these day. There was a live music performace in the afternoon. LPA Martinez reviewed the July activities calendar. LPA Martinez inspected the activity room at the assisted living (AL) side and memory care (MC) side. There were no activities happening in the facility during the proposed times on the July activity calendar. Additionally, the Activities calendar states, "Snack Social at 10:00 AM". LPA Martinez observed no snack social at the AL side and MC side. There were no snacks given at the AL side. However, at the MC side, care staff obtained snacks from the facility kitchen, and snacks were handed out to residents by memory care staff.
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: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024
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 5
Control Number 27-AS-20240708164104
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: 07/12/2024
NARRATIVE
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Furthermore, during the facility visit LPA Martinez inspected a refrigerator located at the front resident common area. LPA Martinez observed the following: refrigerator door handle is broken; frost bite build up in the freezer; no thermometers; and fruit cups, an open water bottle in the freezer, and two coffee cups filled with coffee. During the inspection, LPA Martinez was informed kitchen staff do not monitor this refrigerator and do not stock the refrigerator. LPA Martinez inspected a fruit cup with kitchen staff due to expiration date being unclear. Kitchen staff and LPA Martinez inspect the fruit cup, which determined fruit cup was expired. During another inspection check of the fruit cup, it was determined the fruit cup was not expired. There was no snack check log that included when the refrigerator was stocked with fruit cups, and which staff was monitoring the supply of snacks stored in refrigerator. Moreover, there were no snack stored in the snack tray. LPA Martinez also observed a silver platter on snack table that contained a nail. Moreover, the facility staff removed the refrigerator and snack tray was replenished.

It was also learned facility air conditioners units were not working properly. The facility purchased portable air conditioners for the facility. In addition, the facility is current working with a HVAC company. The facility is also conducting facility temperature check for all resident rooms and common areas.

Because you have been cited for repeating the same violation within 12 months (California Code of Regulations Section (87303(a)), a civil penalty in the amount of $1,000.00 shall be assessed 07/12/2024. Please refer to LIC 421IM form for additional information.

As a result of this investigation, the Department finds these allegations to be Substantiated. A finding that the complaint is substantiated means that the allegations are 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 9099 report, 9099-D page, appeals rights, and LIC421IM were provided to the facility
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20240708164104
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: 07/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/17/2024
Section Cited
CCR
87303(a)
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87303(a) Maintenance and Operation: The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidence by: based on observation, interviews, and file reviews.,
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facility has hired a HVAC company to repair facility air conditioner units, and facility is conducting temperature checks daily for all common areas and resident rooms. Facility agrees to email LPA Martinez Air conditioner repair reports and repair timeline
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 the Licensee did not ensure facility appliances, and air conditioner was in good repair. This posed an immediate health and safety risk to residents in care.
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and temperature check audit logs by 07/17/2024 5:00 PM
Type B
07/26/2024
Section Cited
CCR
87219(a)(1-6)
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87219(a)(1-6)Planned ActivitiesResidents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities. The activities made available shall include. This requirement was not met as evidence by
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Facility staff agrees to email LPA Martinez a plan on how activities will be provided to residents in care by 07/26/2024 by 5:00 PM.
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Based on observation, file review, and interviews, the licensee did not ensure activities were be offered and conducted to residents in care. This posed a potential health and safety risk to residents in care.
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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: 07/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20240708164104
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: 07/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/17/2024
Section Cited
CCR
87555(a)
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87555 (a) General Food Service Requirements: The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner.
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facility replenished the common snack table. In addition, facility staff agrees to email LPA Martinez daily snack procedures and plan by 07/17/2024.
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This requirement was not met as evidence by: based on observation and interviews, the Licensee did not ensure total daily diet/snacks were being provided and in the quantity necessary to meet the needs of the residents. This posed a potential health and safety risk to residents in care.
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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: 07/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5