Failure to Provide Required Mental Health Services
Penalty
Summary
The facility failed to provide appropriate mental health treatment and services to a resident with a diagnosed mental disorder and psychosocial adjustment difficulties. The resident, under the age of 65, had a history of depression, developmental delay, suicide attempt, and required a permanent tracheostomy. The resident exhibited significant behavioral symptoms, including yelling, threatening, cursing, throwing items, striking out, grabbing others, and inappropriate sexual behavior. The care plan included interventions such as antipsychotic medications, behavior monitoring, and psychiatric consultation as indicated. The PASRR Level II determination specifically required specialized services, including psychiatric case consultation, individual therapy, and a neuropsychological assessment. Despite these documented needs and the resident's escalating behaviors, the facility did not arrange for psychiatric case consultation or individual therapy. Progress notes over several months documented repeated behavioral incidents, including aggression toward staff and other residents, and attempts to tamper with the resident's tracheostomy. Staff interviews confirmed that the resident did not receive individual therapy services during his stay, as the facility lacked a contract with a mental health provider for an extended period. The social services director and nursing home administrator both acknowledged the absence of these services, noting that a new contract for mental health services was only recently established, and that the previous provider had stopped coming to the facility some time ago. The lack of mental health services persisted even as the resident's behaviors increased, and there was no evidence in the medical record that the required specialized services were provided. Staff attempted to manage the resident's behaviors with medication adjustments and non-pharmacological interventions such as music, but these did not substitute for the required psychiatric and therapeutic interventions. The deficiency was identified through record review and staff interviews, which confirmed the facility's failure to provide the necessary mental health counseling and therapy services as required by the resident's care plan and regulatory requirements.