Failure to Incorporate PASARR Recommendations and Submit Specialized Service Request
Penalty
Summary
The facility failed to incorporate the recommendations from the PASARR Level II determination and evaluation report into a resident's assessment, care planning, and transitions of care. Specifically, the facility did not submit a request through the Simple LTC portal for a customized manual wheelchair for a resident within the required timeframe set by PASARR. This omission was identified through observation, interviews, and record review, which showed that the need for a customized wheelchair was documented during the PASARR IDT meeting and included in the resident's care plan, but the necessary request for specialized services was not processed as required. The resident involved was an elderly female with diagnoses including developmental disorder of speech and language, dementia, and rhabdomyolysis. She had severe cognitive impairment, was dependent on staff for multiple activities of daily living, and was identified as PASRR positive. The PASARR IDT meeting recommended a customized manual wheelchair as a specialized service, and this was reflected in the care plan and progress notes. However, review of the Simple LTC portal showed no submission of the NFSS (Nursing Facility Specialized Services) request for the wheelchair, despite ongoing documentation in quarterly meetings that the wheelchair was needed and later received. Interviews with facility staff revealed confusion and lack of follow-up regarding responsibility for submitting the NFSS request. The Director of Rehabilitation (DOR) and MDS nurse both indicated that the process was not completed as required, with the previous DOR and therapy staff unsure if the request was ever finalized or submitted. The administrator was not aware of the PASARR IDT's recommendation for the wheelchair and confirmed that the request was not sent through PASARR, but rather the wheelchair was eventually obtained through Medicaid benefits. The facility's policy requires that PASARR recommendations be incorporated into resident care, but this was not followed in this instance.