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F0645
D

Failure to Complete Annual PASARR Level I Screening

Holland, Michigan Survey Completed on 06-25-2025

Penalty

5 days payment denial
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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 required annual Preadmission Screening and Resident Review (PASARR) Level I Screening Form (DCH-3877) was completed for a resident with mental health diagnoses, including anxiety disorder, dementia with psychotic disturbance, and delusional disorders. The resident was found to be cognitively intact, as indicated by a BIMS score of 13 out of 15 on a recent MDS assessment. Documentation review revealed that the most recent Level I PASARR form in the resident's record was completed in November of the previous year, with no subsequent annual form found in the electronic medical record. Interviews with facility staff confirmed that the annual PASARR Level I form had not been completed as required. The Social Services Technician acknowledged the oversight, and the responsible Social Worker indicated that the form was marked as completed in their system but could not be located. Further inquiry with the OBRA coordinator also failed to produce a more recent Level I form, confirming the deficiency in maintaining up-to-date PASARR documentation for the resident.

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