Failure to Complete Required PASRR Follow-Up for Residents with Mental Disorders
Penalty
Summary
The facility failed to follow up on positive Level I Preadmission Screening and Resident Reviews (PASRR) for two residents who screened positive for serious mental illness (SMI). For one resident, the admission record showed diagnoses including unspecified psychosis, unspecified mood affective disorder, and schizophrenia. Documentation from the Department of Health Care Services (DHCS) indicated a positive PASRR Level I screening, but the Level II evaluation was not completed because facility staff were unresponsive to multiple attempts at communication from DHCS. No new Level I PASRR was completed after the case was closed, and the Director of Nursing (DON) could not provide documentation to support the decision not to pursue a Level II PASRR. For another resident, the medical record indicated diagnoses of Alzheimer's, dementia, and unspecified psychosis, with a positive PASRR Level I screening for SMI. The facility did not follow up with a Level II PASRR, and DHCS records showed staff were unresponsive to communication attempts. Additionally, after a significant change in condition to hospice care, a new PASRR screening was not initiated. The DON acknowledged that follow-up was not made and that a PASRR Level I screening should have been completed after the change in condition. Facility policy requires referral for Level II evaluation when Level I screening is positive for mental disorder, intellectual disorder, or related disorder.