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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701388
Report Date: 07/16/2026
Date Signed: 07/16/2026 11:28:05 AM

Unsubstantiated


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
03/27/2026 and conducted by Evaluator Kesha Lewis
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260327112911
FACILITY NAME:BALANCE ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
392701388
ADMINISTRATOR:CAROLYN APPEALFACILITY TYPE:
740
ADDRESS:1321 S. FAIRMONT AVENUETELEPHONE:
(209) 334-3436
CITY:LODISTATE: ZIP CODE:
95240
CAPACITY:136CENSUS: 71DATE:
07/16/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Villanueva Serina TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff are not providing supervision of residents.
Facility is not safeguarding residents’ personal property.
Reporting Requirements.
Facility is not providing hygiene care for resident.
INVESTIGATION FINDINGS:
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On 07/16/2026 LPA Lewis arrived at facility unannounced to deliver findings on the above allegations. LPA explained the reason for the visit to staff.

The department investagated the above allegations and based on the information gathared through interviews and records review, the allegations are UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with resident service specalist, and a copy of this report and LIC 811 provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
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 3
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
03/27/2026 and conducted by Evaluator Kesha Lewis
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260327112911

FACILITY NAME:BALANCE ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
392701388
ADMINISTRATOR:CAROLYN APPEALFACILITY TYPE:
740
ADDRESS:1321 S. FAIRMONT AVENUETELEPHONE:
(209) 334-3436
CITY:LODISTATE:ZIP CODE:
95240
CAPACITY:136CENSUS: 71DATE:
07/16/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Villanueva Serina TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility did not notify residents responsible party of a rate increase.
INVESTIGATION FINDINGS:
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On 07/16/2026 LPA Lewis arrived at facility unannounced to deliver findings on the above allegations. LPA explained the reason for the visit to staff.

The department investagated the above allegations and based on the information gathared through interviews and records review the facility was unable to provided any dated notice that was provided to R1'S responsible party. Therefore the allegation is SUBSTANTIATED. A finding of substantiated means there is a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted, and a copy of this report and LIC 811 provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20260327112911
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: 07/16/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/19/2026
Section Cited
HSC
1569.655
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(a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives setting forth the amount of the increase, the reason for the increase, and a general description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident. This subdivision shall not apply to optional services that are provided by individuals, professionals, or organizations under a separate fee-for-service arrangement with residents.
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Licensee will read the regulation and provide a statemnt of understanding to LPA Lewis by COB on 07/18/2026.
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This requirement was not met as evicenced by: records review the facility provided a unsinged, undated paper that started a rate increase for 1-1-2026. R1's admissions agreament stats they are to give a 60 day notice R1 moved into the facility min December of 2025.
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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 King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3