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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701388
Report Date: 10/10/2025
Date Signed: 10/10/2025 03:20:49 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
08/14/2025 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20250814084722
FACILITY NAME:BALANCE ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
392701388
ADMINISTRATOR:RACHELLE REYESFACILITY TYPE:
740
ADDRESS:1321 S. FAIRMONT AVENUETELEPHONE:
(559) 313-8062
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:136CENSUS: 74DATE:
10/10/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Rachelle ReyesTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Resident sustained unexplained injury while in care
INVESTIGATION FINDINGS:
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On 10-10-2025 at 12:30pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to continue investigation and deliver findings for the above allegation. LPA met with Administrator Rachelle Reyes and explained the purpose of the visit. During this investigation, LPA conducted interviews with five staff members, and reviewed facility file documentation including employee schedules, actual hours worked, incident reports, facility care notes, hospital discharge paperwork, and reporting protocols.

Allegation: Resident sustained unexplained injury while in care. LPA conducted interviews and record reviews as noted above. Based on interviews and record reviews, it was revealed that on or about 7-26-2025, resident1 (R1) sustained a fall outside his room at approximately 1:55pm. As a result of this fall, R1 sustained a possible sacral fracture. A review of caregiver schedule and actual hours worked on this day and time revealed all scheduled staff members were on duty. Care notes reviewed also confirmed the fall event. Interviews conducted revealed that R1 was monitored every 15-30 minutes for safety due to history of unstable ambulation and risk for falling as a result. {Cont. on 9099C}
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025
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-20250814084722
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: 10/10/2025
NARRATIVE
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Additionally, interviews conducted did not reveal any corroborated statements or evidence of lack of appropriate care and supervision of R1. Interviews confirmed date and time of fall with description of R1 found on the floor outside the door of this room with walker beside him. Staff on duty provided pillows for comfort without moving R1 for safety purposes while awaiting for 911 personnel to arrive and assess. Interviews revealed 911 was notified within 1-2 minutes of discovery of fall. Incident was reported to licensing department on or about 8-1-2025.

As a result of the above investigation, it was determined that R1 sustained a fall with possible sacral fracture. It was further determined that although this incident occurred, there is not a preponderance of evidence to conclude this incident was due to a lack of adequate care and supervision or other violation of Title 22 or Health and Safety Code violations, 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 provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2