Failure to Complete and Update PASRR Screenings for Residents with Mental Health Diagnoses
Penalty
Summary
The facility failed to ensure that Pre-admission Screening and Resident Reviews (PASRR) were completed accurately and in a timely manner for seven out of eight residents reviewed. In several cases, residents were admitted with mental health diagnoses such as anxiety disorder, schizophrenia, depression, delusional disorder, and psychosis, but their PASRR Level I screenings either did not reflect these diagnoses or were not updated when new diagnoses were added. For example, one resident with an anxiety disorder and on antianxiety medication had a Level I PASRR that did not identify the diagnosis or trigger a Level II referral, which staff later acknowledged was inaccurate. Another resident with schizophrenia, depression, and anxiety had a Level I PASRR that triggered a Level II referral, but there was no documentation of follow-up or completion of the referral process. Additional deficiencies were observed where residents' PASRR Level I screenings failed to capture new or existing mental health diagnoses, such as delusional disorder or psychosis, even after these were added to the residents' medical records. In some cases, the PASRR forms were not updated for several months after a new diagnosis was made, and staff interviews confirmed that these omissions did not meet expectations. For one resident, the PASRR Level I did not indicate the need for a Level II evaluation despite the presence of a psychotic disorder, and the form was not corrected until months later. Staff interviews revealed a lack of oversight and follow-through in reviewing and updating PASRR evaluations. Social Services staff acknowledged that it was their responsibility to ensure the accuracy of Level I evaluations and to refer cases for Level II evaluation as needed, but admitted that several forms were inaccurate or not updated in a timely manner. In some instances, there was no documentation to confirm that required Level II referrals or invalidations had been completed, and mental health diagnoses such as PTSD and bipolar disorder were not consistently reflected on PASRR forms.