Failure to Complete Required PASRR Evaluations for Residents with Mental Health and Developmental Diagnoses
Penalty
Summary
The facility failed to ensure that three sampled residents received appropriate PASRR (Preadmission Screening and Resident Review) evaluations as required by federal regulations. For the first resident, documentation showed diagnoses including toxic encephalopathy, post-traumatic stress disorder, anxiety disorder, and chronic pain syndrome, with a BIMS score indicating moderate cognitive impairment. Despite these diagnoses and a history of mental health conditions, the PASRR Level 1 screening marked that the resident did not have a serious mental disorder, and no Level II screening was conducted, as confirmed by correspondence from the state agency. The second resident was admitted with diagnoses of toxic encephalopathy, cerebral palsy, depression, and developmental delay of scholastic skills, and also had a BIMS score indicating moderate cognitive impairment. Hospital records noted the need for coordination with the Regional Center due to developmental delay. The PASRR Level 1 screening indicated a developmental or intellectual disability and past Regional Center services, but did not identify a serious mental disorder, and no Level II PASRR was found in the resident's chart. The third resident had diagnoses of depression, hemiplegia and hemiparesis following cerebral infarction, and brain injuries, with a BIMS score indicating moderate cognitive impairment. Physician notes included toxic encephalopathy, anxiety disorder, and major depressive disorder. The PASRR Level 1 was positive for suspected mental illness, but the state agency determined no serious mental illness was present, and no Level II screening was conducted. Interviews with facility staff revealed that PASRR Level 1 screenings completed by acute hospitals were often incorrect, and the facility did not consistently review or correct these errors, resulting in missed Level II screenings for the affected residents.