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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701388
Report Date: 12/26/2025
Date Signed: 01/15/2026 10:13:26 AM

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
12/24/2025 and conducted by Evaluator Noel Wolf Petersen
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251224083630
FACILITY NAME:BALANCE ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
392701388
ADMINISTRATOR:RACHELLE REYESFACILITY TYPE:
740
ADDRESS:1321 S. FAIRMONT AVENUETELEPHONE:
(209) 334-3436
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:136CENSUS: 72DATE:
12/26/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Mery-lyn OteroTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff do not ensure that the facility is free of pests.
INVESTIGATION FINDINGS:
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**This report was ammended to mark the finding as public instead of confidential**
Licensing Program Analyst, LPA, Noel Wolf Petersen arrived unannounced to the facility to conduct a investigation in to the above allegation. LPA met with Mery-lyn Otero to explain the purpose of the visit. LPA observed bugs in the facility, a spider in the lobby and a small flightless bug caught by a resident. The immedate surrounding area where the insect was caught has some areas where bugs could reproduce and feed, cat food dishes, water bowls, bags of alluminium cans, ciggarete waste receptical. The kitchen and garbage cans appeared not to be a source of the insects. LPA conducted interviews of the 2 facility staff and 3 residents, LPA collected the health evaluations for one resident. In interviews mixed representation of the insects exists, in two cases the residents took pictures and made observations of actual insects, amongs many pictures and observations of dust, lint, carpet balls, and paint splatters. the most recent 602 does not indicate any issue with hallucination, a 603 is pending.
Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulation T22 is being cited on the attached LIC 9099D.
Citation issued. A copy of the appeal rights was given, a copy of the report was given to the staff, an exit interview was held.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2025
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 2
Control Number 27-AS-20251224083630
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: 392701388
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/02/2026
Section Cited
CCR
80087
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80087(a)(1) Buildings and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (1) The licensee shall take measures to keep the facility free of flies and other insects.
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Facility will get an exterminator on the schedule to take measures against the observed insect types by the POC date.
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This requirement was not met as evicenced by: direct observation of insects in the facility, as well as sources of insects

This presents and immedate health and safety risk to the clients 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.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2