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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700385
Report Date: 11/14/2024
Date Signed: 11/20/2024 01:33:11 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
11/12/2024 and conducted by Evaluator Victoria Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20241112143723
FACILITY NAME:CORNERSTONE ADULT RESIDENTIAL CAREFACILITY NUMBER:
342700385
ADMINISTRATOR:CRUZ-MADURO, CYNTHIAFACILITY TYPE:
735
ADDRESS:9210 BROMFIELD CTTELEPHONE:
(916) 588-6448
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:4CENSUS: 4DATE:
11/14/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Cynthia Cruz-MaduroTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff lock resident out of the house
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
AMENDED TO CHANGE TO PUBLIC Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 11/14/24 at 2pm and met with Administrator stating the purpose of the visit. During interviews, Administrator iindicated because the television was so loud and was using the phone regarding R2, they did not hear either doorbells. Administrator stated that the front door does not automatically lock. On 11/11/24 there were 3 other residents in the home. LPA observed R1 records which indicate a history of fabrications, able to leave the facility unassisted, and carriers extra continence supplies. A review of Facility Notes and Assessments, allegation is deemed Unsubstantiated based on observation that the 2 doorbells work, and television being utilized loudly by residents, it is unclear if staff heard the bell(s) if it was used or not. The investigation revealed the preponderance of evidence standards has not been met; therefore, the above allegation(s) is found to be 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. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies cited. An exit interview was conducted, and a copy of this report was provided.
Unsubstantiated
Estimated Days of Completion: 30
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
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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