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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216803488
Report Date: 02/17/2022
Date Signed: 02/17/2022 09:44:27 AM

Document Has Been Signed on 02/17/2022 09:44 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 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: 7DATE:
02/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Tina Stanford - Intake Discharge Case ManagerTIME COMPLETED:
09:43 AM
NARRATIVE
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Licensing Program Analyst (LPA) Hansen arrived unannounced to conduct a case management review of facility and met with Tina Stanford the Intake Discharge Case Manger, Administrator Stefen Hainbuch arrived at end of visit.

Todays visit is due to deficiencies cited at annual visit conducted on 12/10/2021 for staff not being background checked and associated to facility, plan of correction has been cleared. LPA checked staff currently working at facility today and all have been background checked and associated.

No deficiencies cited at this time.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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