Failure to Complete and Update PASRR Assessments for Residents with Mental Health Needs
Penalty
Summary
The facility failed to ensure that Pre-admission Screening and Resident Review (PASRR) assessments were accurately completed and updated for residents with mental disorders or intellectual disabilities. For three residents reviewed, there were significant lapses in the PASRR process. One resident with diagnoses of depression and anxiety had a Level 1 PASRR screening indicating the need for a Level 2 referral due to serious mental illness (SMI), but the referral was not made until seven months after the initial assessment. Another resident with anxiety and a mood disorder, who was prescribed antipsychotic medication, had a Level 1 PASRR submitted, but there was no documentation of follow-up with the State PASRR office or evidence of obtaining Level 2 services. For a third resident, hospital staff identified SMI indicators on the Level 1 PASRR, but did not specify the type of SMI, and a subsequent Level 2 evaluation determined no SMI based on hospital records. However, the resident was later prescribed antidepressant medication for an anxiety disorder, and the diagnosis was added to their records without an updated Level 1 PASRR being completed. Staff interviews confirmed that PASRRs were not updated in a timely manner when residents' mental health diagnoses changed or when new medications were prescribed. The facility's policy required timely validation and submission of Level 1 and Level 2 PASRRs, especially with significant changes in residents' mental health status, but these procedures were not followed for the residents in question. Documentation and communication with the State PASRR office were also lacking, resulting in incomplete or delayed assessments and referrals.