Failure to Accurately Update PASRR for Resident with Schizophrenia
Penalty
Summary
The facility failed to update the Pre-admission Screening and Resident Review (PASRR) for a resident who was admitted with a diagnosis of schizophrenia. Upon admission, the resident's medical record indicated diagnoses of schizophrenia, altered mental status, and dementia. However, the PASRR Level I screening completed at the hospital and used for admission did not include the schizophrenia diagnosis, marking the question regarding serious mental illness as 'NO.' This resulted in the PASRR resolution status being set to 'Level II not required,' which was inaccurate given the resident's actual condition. Interviews with facility staff, including the MDS Nurse and Assistant Directors of Nursing, revealed that the skilled nursing facility did not identify the discrepancy in the PASRR upon the resident's admission. The staff acknowledged that the PASRR should have been reviewed for accuracy and amended if necessary, but this process was not followed. The omission was only discovered later, and the PASRR was subsequently updated to reflect the correct diagnosis of schizophrenia. Further review of facility practices showed that there was no specific policy or procedure in place for the PASRR process. Staff relied on a general PASRR Level I Screening Assessment Guide, which outlined the need for accurate and current information and specified that major clinical errors required a new screening. The guide also indicated that certain PASRR resolutions, such as 'Categorical Review,' were not valid for admission to a Medicaid-certified skilled nursing facility, yet the resident's revised PASRR was marked as such, pending further review.