Failure to Complete PASARR Level II Referral for Resident with Serious Mental Illness
Penalty
Summary
The facility failed to complete a referral for a Level II PASARR (Pre-Admission Screening and Resident Review) for a resident with a documented history of serious mental illness. The resident was admitted with diagnoses including schizophrenia, polydipsia, hyponatremia, and panic disorder. Initial PASARR Level I completed by the hospital did not indicate serious mental illness, but subsequent documentation, including a later Level I, hospital discharge summaries, and provider notes, revealed ongoing symptoms such as suicidal ideation, auditory hallucinations, and behaviors related to excessive fluid intake. Despite these indicators, there was no evidence in the medical record that a Level II PASARR referral was made. Staff interviews confirmed the resident exhibited behaviors consistent with serious mental illness, including verbal outbursts, paranoia, and noncompliance with fluid restrictions, which led to repeated hospitalizations for hyponatremia and suicidal ideation. Social services staff acknowledged the lack of current mental health involvement and the absence of a Level II PASARR referral. The unit manager and administrator both agreed that a referral should have been completed, but it was not done.