Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00289171 Renewal 05/27/2026 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.181(a)Individual #1 had an assessment completed 7/23/2024, and then again on 2/6/2026. This exceeds the annual requirement. Each individual shall have an initial assessment within 1 year prior to or 60 calendar days after admission to the residential home and an updated assessment annually thereafter. The initial assessment must include an assessment of adaptive behavior and level of skills completed within 6 months prior to admission to the residential home. Annual Assessment was completed as of 02/06/2026. A new Program Specialist was hired in January 2026-training during onboarding included overview of reporting timelines for annual assessments. 07/29/2026 Implemented
6400.165(g)Individual #1 is prescribed medications to treat the symptoms of a psychiatric illness. There is no documentation of ongoing medical reviews by a licensed physician every 3 months.If a medication is prescribed to treat symptoms of a psychiatric illness, there shall be a review by a licensed physician at least every 3 months that includes to document the reason for prescribing the medication, the need to continue the medication and the necessary dosage.Psychiatric med review was completed for Individual #1 on 04/23/2026. 07/29/2026 Implemented
6400.207(5)(III)On 5/28/2026 at 11:15am, in Individual #1's bedroom there were installed bed rails on individual's bed. Individual has a valid doctor's recommendation; however, the Bedrail usage was not documented in the assessment, and neither the Assessment nor Individual Service plan includes periodic relief of the device to allow freedom of movement.A mechanical restraint, defined as a device that restricts the movement or function of an individual or portion of an individual's body. A mechanical restraint includes a geriatric chair, a bedrail that restricts the movement or function of the individual, handcuffs, anklets, wristlets, camisole, helmet with fasteners, muffs and mitts with fasteners, restraint vest, waist strap, head strap, restraint board, restraining sheet, chest restraint and other similar devices. A mechanical restraint does not include the use of a seat belt during movement or transportation. A mechanical restraint does not include a device prescribed by a health care practitioner for the following use or event: Protection from injury during a seizure or other medical condition, if the individual can easily remove the device or if the device is removed by a staff person immediately upon the request or indication by the individual, and if the individual plan includes periodic relief of the device to allow freedom of movement.Update was made to annual assessment to include bedrail usage and periodic relief of the device to allow freedom of movement on 05/27/2026. 07/10/2026 Implemented
SIN-00247815 Renewal 07/11/2024 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.151(a)Direct Support Profession #1, date of hire 12/30/23, had a physical examination completed on 09/28/22 prior to employment. This exceeds 12 months prior to employment. A staff person who comes into direct contact with the individuals or who prepares or serves food, for more than 5 days in a 6-month period, including temporary, substitute and volunteer staff, shall have a physical examination within 12 months prior to employment and every 2 years thereafter. Direct Support Professional #1 was a staff from a temporary staffing agency. KZL Agency will notify staffing agency of requirement for physical examination to be no more than 12 months old when sending to work at KZL Agency. KZL Agency will request and review physical examination of all temp agency staff prior to allowing staff to work in the home, as is done with training records. This will be completed by KZL Agency's Personnel Manager, who is responsible for collecting all onboarding paperwork, including physical and TB test, prior to an employee¿s first day of work. 08/14/2024 Implemented
6400.207(5)(III)On 07/12/24 at 11:17 AM, Individual #1's bed contained full bedrails that restrict the movement or function of the individual's body. The agency does not currently have a prescription order from a physician for the bedrails. The most current assessment dated 01/22/24 does not include whether the individual "can easily remove the device or if the device is removed by a staff person immediately upon the request or indication by the individual, and if the individual plan includes periodic relief of the device to allow freedom of movement."A mechanical restraint, defined as a device that restricts the movement or function of an individual or portion of an individual's body. A mechanical restraint includes a geriatric chair, a bedrail that restricts the movement or function of the individual, handcuffs, anklets, wristlets, camisole, helmet with fasteners, muffs and mitts with fasteners, restraint vest, waist strap, head strap, restraint board, restraining sheet, chest restraint and other similar devices. A mechanical restraint does not include the use of a seat belt during movement or transportation. A mechanical restraint does not include a device prescribed by a health care practitioner for the following use or event: Protection from injury during a seizure or other medical condition, if the individual can easily remove the device or if the device is removed by a staff person immediately upon the request or indication by the individual, and if the individual plan includes periodic relief of the device to allow freedom of movement.KZL Agency completed the Mechanical Restraint Decision Tree located in the Chapter 6400 RCG. The results of the decision tree were that the bed rails were not considered a mechanical restraint as the individual plan allows for periods of relief from the device to allow freedom of movement. On 7/16/2024, KZL Agency received a faxed letter from the individual's PCP dated 7/12/2024 serving as an order for bed rails for safety purposes stemming from Kalen's extensive medical diagnoses. Upon receipt of this order, KZL Agency updated individual's Residential Assessment to reflect the need for bed rails. KZL Agency reached out to individual's SC to request an update be made to individual's ISP demonstrating the use of bedrails. This request was sent on 7/17/2024 with a second request being sent on 8/2/2024. KZL Agency received an email response from SC on 8/5/2024 stating that the update had been made to the ISP and that SC was awaiting plan be approved by an SC supervisor. As of 8/9/2024, documentation can be found in the General Health and Safety Risk section of individual's ISP. 08/09/2024 Implemented
SIN-00221595 Unannounced Monitoring 03/22/2023 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.22(d)(2)Individual #1's financial ledger from 2/15/2023 to 3/17/2023 does not accurately document the funds received and dispersed for the individual.(2) Disbursements made to or for the individual. Residential Manager reviewed financial ledger along with receipts for Individual #1. After all expenses and deposits were correctly entered, financial ledger is accurate. 07/31/2023 Implemented
6400.67(b)There is an uncapped pipe that connects to the sewer line on the floor of the basement of the home posing a tripping and falling hazard and possible exposure to sewage gas. Floors, walls, ceilings and other surfaces shall be free of hazards.The pipe does not currently connect to a sewage pipe. A temporary cap has been placed to prevent a tripping and falling hazard. It will permanently fixed by 4/30/2023. 04/30/2023 Implemented
6400.81(k)(6)There is no mirror in Individual #1's bedroom. There is no mirror in Individual #2's bedroom.In bedrooms, each individual shall have the following: A mirror. Mirrors will be purchased and placed in both bedrooms 04/14/2023 Implemented
SIN-00267872 Renewal 06/10/2025 Compliant - Finalized
SIN-00227985 Renewal 07/18/2023 Compliant - Finalized
SIN-00227105 Unannounced Monitoring 06/15/2023 Compliant - Finalized
SIN-00215612 Renewal 11/17/2022 Compliant - Finalized