Failure to Update Care Plan and Initiate PASRR Level II Specialized Services
Penalty
Summary
The facility failed to update the care plan and initiate specialized services for a resident as required by the PASRR Level II determination. Clinical record review and staff interviews revealed that the resident, who had severely impaired cognition, moderate intellectual disabilities, and an unspecified mood disorder, was prescribed antipsychotic, antianxiety, and anticonvulsant medications. The PASRR Level II outcome specified the need for ongoing psychiatric medication management by a psychiatrist or psychiatric ARNP, as well as facilitation of family involvement and supportive counseling from facility staff. However, the care plan lacked a focus area and interventions to address these specialized services. Interviews with facility staff, including the social worker, MDS coordinator, and DON, confirmed that the care plan had not been updated to reflect the PASRR Level II requirements. The social worker initially believed that psychiatric services were already in place, but later acknowledged that the resident had not received such services since admission. The DON also confirmed that the care plan should have been updated and that the facility had not addressed the PASRR Level II prior to the survey date. The facility did not have a policy related to PASRRs and relied on CMS regulations.