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F0645
D

PASARR Screening Failed to Identify Resident's Mental Health Diagnoses

Riverside, California Survey Completed on 06-05-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure that a Preadmission Screening and Resident Review (PASARR) Level I screening accurately reflected the presence of diagnosed mental disorders for a resident. Specifically, a resident was admitted with diagnoses including bipolar disorder and anxiety disorder, but the PASARR Level I screening was marked as negative for serious mental illness (SMI). The screening form incorrectly indicated that the resident did not have a serious diagnosed mental disorder, despite documentation of such diagnoses in the admission record. During interviews and record reviews, it was confirmed by two Minimum Data Set Nurses (MDSNs) that the mental health diagnoses were missed during the PASARR screening process. One nurse acknowledged that the question regarding serious mental illness should have been answered affirmatively, and both nurses recognized that this error could have changed the PASARR result from Level I Negative to Level I Positive, which would have required further evaluation prior to admission. The facility's policy states that a positive Level I screen necessitates a Level II evaluation before admission.

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