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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 216803488
Report Date: 09/13/2022
Date Signed: 09/13/2022 11:53:46 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/22/2022 and conducted by Evaluator Shannan Hansen
COMPLAINT CONTROL NUMBER: 21-AS-20220822091726
FACILITY NAME:CASA RENE SOCIAL REHABFACILITY NUMBER:
216803488
ADMINISTRATOR:HAINBUCH, STEFEN ROQUEFACILITY TYPE:
772
ADDRESS:1109 SIR FRANCIS DRAKE BLVDTELEPHONE:
(415) 419-6900
CITY:KENTFIELDSTATE: CAZIP CODE:
94904
CAPACITY:10CENSUS: 5DATE:
09/13/2022
UNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Behavioral Health Regional Director of Buckelew - Connie MannTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility violated residents personal rights
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Hansen conducted a complaint investigation regarding the allegations listed above. LPA arrived unannounced on this day for the purpose of delivering findings of the above allegations. LPA met with Behavioral Health Regional Director of Buckelew - Connie Mann. Regional Director informed there will be a new Administrator for facility in 30 days.

Staff is threatening resident in care – Complainant alleges that facility staff are threatening client in care (C1) to be brought to the hospital if C1 is not accepted to next facility after discharge from current program at (Casa Rene). Per LPAs interview with Assistant Program Director revealed that Casa Rene program is a 21-day program with a maximum stay of 28 days. LPA reviewed C1’s admission agreement and agreed upon house rules which indicate length of admission. Assistant Program Director informed LPA that throughout the stay of a client they are continuously informed where they are at in the program and what needs to happen to prepare for their discharge and future placement. LPA was informed that this information provided to C1 and any other clients in care is not intended to be threatening but to prepare them for their transition.
Continue on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022
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 3
Control Number 21-AS-20220822091726
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: CASA RENE SOCIAL REHAB
FACILITY NUMBER: 216803488
VISIT DATE: 09/13/2022
NARRATIVE
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LPA was unable to identify any witness or obtain additional information to support staff threatened C1 while in care. LPA conducted multiple interviews with complainant and was provided inconstant information. Complainant informed LPA that allegation to be forced to take medication was not at this facility but at the local hospital. Complainant also informed LPA that personal belongings were not held at the facility, this was in reference to a previous residence.
Although the allegations above may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are unsubstantiated
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3