392701388-4-8-2025-27-AS-KHOS-DFRN8N-20250415101438

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392701388
Report Date: 04/08/2025
Date Signed: 04/08/2025 02:16:23 PM

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
01/13/2025 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20250113134019

FACILITY NAME:	BALANCE ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	392701388
ADMINISTRATOR:	AGUILAR, JOHNATHAN		FACILITY TYPE:	740
ADDRESS:	1321 S. FAIRMONT AVENUE		TELEPHONE:	(559) 313-8062
CITY:	LODI	STATE: CA	ZIP CODE:	95240
CAPACITY:	136	CENSUS: 64	DATE:	04/08/2025
		UNANNOUNCED	TIME BEGAN:	10:01 AM
MET WITH:	Rachelle Reyes		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility not following covid protocols
No hot water in mens bathroom in hallway
Inadequate emergency food supply

INVESTIGATION FINDINGS:

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On 4/8/2025 at 10:01am, Licensing Program Analysts (LPAs) Michael Bilger and Noel Wolf Petersen arrived unannounced to deliver findings for the allegations noted above. LPA met with Administrator Rachelle Reyes and explained the purpose of the visit. During this investigation, LPA conducted interviews with nine staff members, three residents in care, and conducted observations on 1-17-2025 and 4-8-2025 within the memory care unit of facility, assisted living, and kitchen area. Additionally, LPA reviewed facility documentation including facility menus and facility’s infection control policy and procedures.

Allegation: Facility not following covid protocols. LPA conducted interviews, record reviews, and observations as noted above. Based on interviews and observation it was revealed that facility had previously experienced a covid outbreak in the memory care unit and assisted living section which was reported to licensing department. It was further revealed that facility engaged in covid safety protocols at the onset of the outbreak including utilization of masks, gowns, gloves, and hand sanitizer as necessary. Social distancing of memory care and other residents was in place as well. {Cont. on 9099C}

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20250113134019

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
	VISIT DATE: 04/08/2025

NARRATIVE

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Based on review of facility’s infection control policy and procedures, it was determined that facility provided a linear approach to covid safety. LPA’s observation of facility revealed adequate amounts of personal protective equipment (PPE) in place as well as availability of hand sanitizers and isolation carts. As a result, there is a not a preponderance of evidence to conclude facility was not following necessary covid protocols, therefore, this allegation is UNSUBSTANTIATED.

Allegation: No hot water in men’s bathroom in hallway. LPA conducted interviews and observations as noted above. Based on interviews conducted it was revealed that facility has consistently maintained hot water in men’s bathrooms and all other sections of facility since 1/1/2025 to current. Observations conducted revealed adequate hot water in men’s bathrooms and other sections throughout facility. As a result, there is not a preponderance of evidence to conclude facility has not maintained hot water availability in men's bathroom and other areas of facility, therefore, this allegation is UNSUBSTANTIATED.

Allegation; Inadequate emergency food supply. LPA conducted interviews, observations, and record reviews as noted above. Based on interviews and observations, it was revealed that facility has consistently maintained adequate amount of food including two days of perishable and seven days of non-perishable items necessary for facility’s census. Observations conducted revealed facility has a designated section for emergency food which was stocked with adequate amounts. A review of facility’s menus revealed food items matched facility’s current stock of food on hand. As a result, there is not a preponderance of evidence to conclude facility did not maintain adequate emergency food supply, therefore this allegation is 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 Administrator and a copy of this report was provided. Appeal rights and LIC 811 provided.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025

LIC9099 (FAS) - (06/04)

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