Failure to Coordinate PASRR Assessments for Residents with New Mental Health Diagnoses
Penalty
Summary
The facility failed to coordinate assessments with the Preadmission Screening and Resident Review (PASRR) program for residents who developed newly evident or possible serious mental disorders after admission. Specifically, for five out of six residents reviewed, there was no documentation that the facility referred these residents to the appropriate state-designated authority for evaluation after new mental health diagnoses were identified. For example, one resident was initially screened for anxiety disorder only, but was later diagnosed with recurrent mild major depressive disorder and PTSD, with no evidence of referral for further PASRR evaluation. Another resident was initially screened for anxiety disorder, but was subsequently diagnosed with bipolar disorder, again without documentation of referral for a Level II PASRR screening. Additionally, three other residents were admitted without any mental illness indicated on their initial PASRR screenings, but were later diagnosed with major depressive disorder, adjustment disorder with depressed mood, and anxiety. Clinical records and psychiatric evaluation notes confirmed these new diagnoses and histories of psychiatric illness, yet there was no evidence that the PASRR assessments were updated or that referrals were made as required. During interviews, the Director of Nursing acknowledged that the PASRRs for these residents were not correct and should have been updated to reflect the new diagnoses and initiate appropriate screenings.