Inaccurate MDS Assessment of PASRR Status
Penalty
Summary
The facility failed to ensure that the Minimum Data Set (MDS) assessment accurately reflected a resident's status. A review of the medical records for a resident admitted with diagnoses including Major Depressive Disorder and Bipolar Disorder showed that the Pre Admission Screening and Assessment Resident Review (PASRR) indicated a Level II determination, confirming the presence of a serious mental illness and recommending nursing home admission. However, the resident's annual MDS assessment incorrectly coded Section A1500 as 'no' to the question of whether the resident was considered by the state Level II PASRR process to have a serious mental illness. This discrepancy was confirmed during an interview and record review with the Director of Nursing, who acknowledged that the PASRR status was inaccurately documented in the MDS.