342700385-4-22-2026-27-AS-SRIN-DUQUWF-20260604155637

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700385
Report Date: 04/22/2026
Date Signed: 04/22/2026 02:33:49 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
08/19/2025 and conducted by Evaluator Kevin Gould

COMPLAINT CONTROL NUMBER: 27-AS-20250819084625

FACILITY NAME:	CORNERSTONE ADULT RESIDENTIAL CARE		FACILITY NUMBER:	342700385
ADMINISTRATOR:	CRUZ-MADURO, CYNTHIA		FACILITY TYPE:	735
ADDRESS:	9210 BROMFIELD CT		TELEPHONE:	(916) 588-6448
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	4	CENSUS: 4	DATE:	04/22/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Cynthia Cruz-Maduro		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not appropriately administer resident's medication.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to the Cornerstone Adult Residential Care ARF on 4/22/26 at 9:30am to conclude the investigation of the above allegation and to deliver the findings. LPA met with Administrator and together discussed the investigation details.

Based on the interviews and statements obtained during the investigation process, the allegations cannot be substantiated. The department conducted interviews with multiple staff and residents and reviewed documentation for medication administration and current medication orders. Records indicated that R1 was prescribed two scheduled medications and two PRN or as needed medications. Per staff records they have documented medication refusal for the scheduled medications and refusals for PRN medications offered by staff. Staff interviewed denied any plan or written documentation from R1's physician discontinuing medications.

Report Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026

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-20250819084625

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: CORNERSTONE ADULT RESIDENTIAL CARE	FACILITY NUMBER: 342700385
	VISIT DATE: 04/22/2026

NARRATIVE

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Per tittle 22 regulations, all medications are given per the physician's instructions. LPA was unable to corroborate statements that medications were not to be given to R1 by RP. LPA observed no documentation that facility should hold medications for R1 for any duration of time.

Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of Medication are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed.

There are no deficiencies noted or cited per California Code Regulation, TITLE 22. Exit interview was conducted with the facility administrator. Appeal Rights were issued, and a copy of this report was left at the facility.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026

LIC9099 (FAS) - (06/04)

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