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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701388
Report Date: 12/20/2024
Date Signed: 12/20/2024 01:51:24 PM

Document Has Been Signed on 12/20/2024 01:51 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:
12/20/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Jonathan AguilarTIME VISIT/
INSPECTION COMPLETED:
01:50 PM
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On 12/20/2024, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to amend pre-licensing report from visit on 12/19/24. LPA met with Administrator Jonathan Aguilar and explained the purpose of the visit. LPA amended report regarding capacity and left copy with 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: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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