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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701388
Report Date: 12/19/2024
Date Signed: 12/20/2024 01:40:08 PM

Document Has Been Signed on 12/20/2024 01:40 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:
392701388
ADMINISTRATOR/
DIRECTOR:		AGUILAR, JOHNATHANFACILITY TYPE:
740
ADDRESS:1321 S. FAIRMONT AVENUETELEPHONE:
(559) 313-8062
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY: 145CENSUS: 59DATE:
12/19/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Jonathan AguilarTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Michael Bilger and Licensing Program Manager (LPM) Liza King conducted an unannounced pre-licensing visit to this facility on 12-19-2024 at 9:45am and was met by current Administrator Jonathan Aguilar. Brief interview was conducted with the Administrator.

It was learned that this facility is a residential care facility for the elderly (RCFE) applying for licensure due to change of ownership, and will now serve up to 136 non-ambulatory clients of which 30 may be bedridden, and 30 may be hospice due to staffing and office room changes. There are currently 59 clients present during today's pre-licensing visit. Tour of the facility was conducted. Dining area, living area, and all other areas intended for resident use were toured and observed to be furnished and maintained in compliance at this time. LPA observed no obstruction of emergency exits. Exit signs in place as appropriate. Fire extinguishers in place in hallways, kitchen, and other areas are fully charged with expiration date of 9/12/24. Facility map indicating emergency exits posted in appropriate locations. Resident rights poster in place. Kitchen area was toured. Food supply for 2-day perishable and 7-day nonperishable quantities were reviewed to make sure that this facility was in compliance at this time.
Medication room, located in assisted living and memory, was observed to be locked and inaccessible to residents in care. First aid kit was observed to be present and contained all required components at this time. A tour of various resident bedrooms was conducted. Furnishings and furniture intended for use by the clients were observed to be sufficient and able to meet the needs of the clients at this time. A tour of various resident bathrooms was conducted. Hot water temperatures were taken and measured within the range of 105-120 degrees. Linen closets were observed to contain a sufficient supply of towels and linens able to meet the needs of the residents at this time. LPA and LPM reviewed five resident records as part of this investigation to ensure compliance.

{Cont. on 809C}
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 392701388
VISIT DATE: 12/19/2024
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A tour of the exterior grounds was conducted. A review of the facility perimeter fence, side gates, delayed egress doors, and walkways were observed to be maintained in compliance at this time.

This facility has been found to be in compliance at this time. There were no deficiencies observed during today's Pre-licensing visit. Component III waived due to experience of Administrator. An exit interview was conducted with Administrator and a copy of this report was provided. .
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
LIC809 (FAS) - (06/04)
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