Failure to Complete Accurate PASARR Screening for Resident with Mental Disorder
Penalty
Summary
The facility failed to ensure that a Preadmission Screening and Resident Review (PASARR) Level I was accurately completed for a resident with a diagnosis of recurrent and unspecified major depressive disorder. The resident was admitted with this diagnosis and was receiving daily antidepressant medication, as documented in the Minimum Data Set (MDS) and Medication Administration Record. However, the Level I PASARR form did not indicate the presence of a mood disorder under the Serious Mental Illness (SMI) indicators section, and therefore, no Level II evaluation was initiated. Interviews with facility staff confirmed that the PASARR should have been obtained prior to admission and reviewed for accuracy by social services. The Director of Nursing acknowledged that the PASARR for this resident was not accurate and should have been updated and sent for Level II evaluation before admission. This deficiency was also noted as a repeat issue from a previous survey.