Failure to Resubmit PASRR After Change in Mental Health Status
Penalty
Summary
The facility failed to resubmit a Level I Preadmission Screening and Resident Review (PASRR) as required for a resident who developed or was identified with mental health diagnoses and was prescribed psychotropic medications after admission. The facility's policy states that a negative Level I PASRR screen permits admission unless a possible serious mental disorder or intellectual disability arises later, in which case a new screening and referral for Level II evaluation must occur. The resident in question was admitted with a negative Level I PASRR obtained from the hospital, which indicated no serious mental disorder or psychotropic medication use at the time of admission. After admission, the resident was diagnosed with psychotic disorder, dementia with behavioral disturbance, and anxiety disorder, and was prescribed antipsychotic and antianxiety medications. The resident's Minimum Data Set (MDS) assessment showed severe cognitive impairment and ongoing use of psychotropic medications. The care plan and physician orders reflected the presence of psychosis, the use of olanzapine, and monitoring for side effects and behavioral symptoms. Despite these changes in the resident's condition and treatment, the facility did not resubmit the PASRR as required by policy and regulation. Interviews with facility staff, including the Admissions Co-Director, Business Development Director, DON, and MDS Coordinator, confirmed that the PASRR process was not followed when the resident's diagnoses and medication regimen changed. Staff acknowledged that a new PASRR should have been completed when the resident was started on routine psychotropic medication and developed new mental health diagnoses. The deficiency was identified through record review and staff interviews, which revealed a lack of compliance with PASRR requirements for residents whose mental health status changes after admission.