Failure to Complete Required PASARR Level II Evaluation for Resident with Mental Disorders
Penalty
Summary
The facility failed to ensure that a resident with a history of mental disorders received a required Level II Preadmission Screening and Resident Review (PASARR) evaluation. The resident was originally admitted and later readmitted with diagnoses including schizophrenia, depression, and seizures. Despite these diagnoses, the admission record and subsequent assessments did not trigger a PASARR Level II evaluation, as the initial PASARR Level I incorrectly indicated the absence of mental disorders. The Director of Nursing (DON) acknowledged responsibility for reviewing PASARRs and confirmed that a new PASARR should have been submitted upon the resident's readmission, especially after the diagnoses of schizophrenia and depression were established. The resident's medical records indicated significant cognitive and functional impairments, including dependence on staff for multiple activities of daily living and a lack of capacity to make decisions. The facility's policy required all new admissions and readmissions to be screened for mental disorders, intellectual disabilities, or related disorders per the PASARR process. However, this process was not followed for the resident in question, resulting in the resident not being appropriately screened for mental illness upon readmission.