Failure to Complete PASARR Level II Referrals After 30-Day Exempted Hospital Stay
Penalty
Summary
The facility failed to ensure that two residents admitted under an exempted hospital discharge were properly referred for a PASARR Level II evaluation after remaining in the facility for more than 30 days. For one resident, the quarterly assessment documented admission from the hospital with diagnoses including traumatic brain injury, muscle weakness, malnutrition, and the use of anti-depressant medications. The Level I PASARR completed prior to admission indicated serious mental health indicators, but a Level II PASARR was not initiated after the resident stayed beyond the 30-day exemption period. Record review confirmed the resident continued to reside in the facility past the expected discharge date, with no evidence of a Level II referral as required. Similarly, another resident was admitted with diagnoses of dementia, anxiety, and depression, and had severely impaired cognition. The Level I PASARR indicated the resident met criteria for an exempted hospital discharge, with instructions that a Level II evaluation was necessary if the resident remained beyond 30 days. The resident stayed in the facility for over 60 days, but no referral for a Level II PASARR was made. Staff interviews confirmed that the required referrals were not completed for either resident after the 30-day period elapsed.