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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 317005902
Report Date: 11/05/2025
Date Signed: 11/06/2025 09:59:37 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
09/11/2025 and conducted by Evaluator Kevin Mknelly
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20250911093306
FACILITY NAME:CORNERSTONE CRISIS RESIDENTIALFACILITY NUMBER:
317005902
ADMINISTRATOR:JENNA ALLENFACILITY TYPE:
772
ADDRESS:101 CIRBY HILLS DRIVETELEPHONE:
(916) 788-8144
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:14CENSUS: 5DATE:
11/05/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jenna AllenTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff mismanaged clients medication
INVESTIGATION FINDINGS:
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On 11/5/25, Licensing Program Analyst (LPA) Kevin Mknelly spoke to Jenna Allen, Administrator to deliver complaint findings for the above allegation.
LPA reviewed resident records, facility records and conducted extensive interviews.
LPA finds that the allegations cited above are substantiated.

Verbal reports are that R1’s Medication was delivered to the facility on 7/23/25 some time in the late afternoon. The facility’s Medication Administration Record (MAR) indicates that R1’s medications were not dispensed to R1 until 7/24. Therefore, facility staff failed to assist R1 with their prescribed dose of medication on 7/23/25 at 8 PM.
Regarding the management of R1’s medication at admission, it is not a requirement for individuals to have their medications in possession at the time of admission into Cornerstone. For individuals referred from an inpatient setting, Cornerstone requires that the referring hospital submit a discharge medication list and to call medications into an area pharmacy, who will deliver the medications to Cornerstone. At the time of a
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Maribeth Senty
NAME OF LICENSING PROGRAM ANALYST: Kevin Mknelly
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
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 5
Control Number 59-AS-20250911093306
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CORNERSTONE CRISIS RESIDENTIAL
FACILITY NUMBER: 317005902
VISIT DATE: 11/05/2025
NARRATIVE
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discharge from a referring hospital, to pharmacy receiving orders, to R1 arriving at the facility, the facility was not aware of any issues that may have arisen with prescriptions being filled until R1 arrived. When R1 arrived at the facility and medications had not, it was reported that facility administrator notified R1’s responsible party to inform them on that there was a problem that precluded the pharmacy to not have filled R1’s medication. It is, therefore, the responsibility of the prescribing provider (Hospital) and the pharmacy filling the prescription to ensure accurate information, including insurance verification.

As a result of this investigation, LPA finds allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care, or personal rights violation, to clients/residents in care.

Report reviewed with Administrator. Copy of this report and appeal rights provided.
NAME OF LICENSING PROGRAM MANAGER: Maribeth Senty
NAME OF LICENSING PROGRAM ANALYST: Kevin Mknelly
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 59-AS-20250911093306
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CORNERSTONE CRISIS RESIDENTIAL
FACILITY NUMBER: 317005902
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/12/2025
Section Cited
CCR
81075(b)
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Health-Related Services (b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. This requirement was not met based on statements and records finding staff failed to assist with R1’s medication on
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The immediate issues leading to the medication errors noted have been resolved.
Licensee agrees to submit a medication management plan to include from client referral, confirm medication, confirm pharmacy fill and delivery, creation and updates of MARs, med passing and documentation.
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7/23/25. This posed an immediate risk to client.
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Further, the licensee will designate a qualified oversight memeber of corporate office to be physically present weekly four a minimum of four consecitive weeks with no medication errors. The person identified for the role will be identified in this plan.
This POC is due by 11/12/25.
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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.
NAME OF LICENSING PROGRAM MANAGER: Maribeth Senty
NAME OF LICENSING PROGRAM ANALYST: Kevin Mknelly
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
09/11/2025 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20250911093306

FACILITY NAME:CORNERSTONE CRISIS RESIDENTIALFACILITY NUMBER:
317005902
ADMINISTRATOR:JENNA ALLENFACILITY TYPE:
772
ADDRESS:101 CIRBY HILLS DRIVETELEPHONE:
(916) 788-8144
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:14CENSUS: 5DATE:
11/05/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jenna AllenTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff did not safeguard client personal property
INVESTIGATION FINDINGS:
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On 11/5/25, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with Administrator.

LPA conducted records review, facility plan of operations, admissions procedures and extensive interviews.
LPA is unable to find and or meet the preponderance, per policy.

Records and statements found that R1 smoked and shared their personal supply of cigarettes. Cigarettes were supplied to R1 by a family member. As the cigarettes are dispersed to the client upon request, Title 22 does not require an accounting of the cigarettes, nor is the facility staff responsible for the client who may give the cigarettes to others.
In the case of R1’s transfer from the facility by emergency responders, R1 reportedly chose what acceptable belongings they took with them when transported from the facility. A family member picked up the remainder of R1’s belongings a few days later.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Maribeth Senty
NAME OF LICENSING PROGRAM ANALYST: Kevin Mknelly
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 59-AS-20250911093306
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CORNERSTONE CRISIS RESIDENTIAL
FACILITY NUMBER: 317005902
VISIT DATE: 11/05/2025
NARRATIVE
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As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview with administrator and report provided.
NAME OF LICENSING PROGRAM MANAGER: Maribeth Senty
NAME OF LICENSING PROGRAM ANALYST: Kevin Mknelly
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5