Senior Care Records.

Facility Evaluation Report

Kirby Parkside, Santa Rosa06/05/2025Licence 496802077

Capacity3
Census1
Date signed06/05/2025 02:42:43 PM
Name of licensing program analystShannan Hansen
Name of licensing program managerBethany Moellers
The inspector’s account

Licensing Program Analyst (LPA) Hansen conducted an unannounced case management Legal/ Non-compliance inspection to this facility and was greeted by Licensee Janet Kirby. LPA is following up on items that were concerning to ensure compliance at non-compliance conference dated 3/05/25:

Timely Medical Attention: Facility failed to seek timely medical attention. Facility submitted a plan of correction on May 17, 2024.

Reporting Requirements: Facility didn’t submit to CCL required unusual incident report when client had a change in condition and was transported to hospital. Facility submitted a plan of correction on May 14, 2024.

Retain Original Client Records : Facility sent all of clients records with ambulance instead of keeping a copy as required by regulation 80070(g) for 3 years after separation of client from facility. Facility submitted a plan of correction on May 10, 2024.

Licensee placed on a compliance plan for 2 years.

No citations issued during today's inspection. Exit interview conducted with Licensee and copy of the report was given.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction