Inaccurate and Incomplete PASRR Level I Screenings for Residents With Mental Illness
Penalty
Summary
The deficiency involves the facility’s failure to ensure accurate completion of Preadmission Screening and Resident Review (PASRR) Level I screenings for five residents with actual or potential mental illness or related conditions. For one resident with major depressive disorder, PTSD, and unspecified dementia, the PASRR Level I form section asking whether there was a diagnosis or suspected mental illness was left unanswered. The Admission Director later acknowledged that major depressive disorder is a mental illness and that the admission department was responsible for completing the PASRR, confirming the screening was incorrect because the key mental illness question was not answered. Another resident with a diagnosis of major depressive disorder had a PASRR Level I in which Section C, the mental illness identification section listing mood and other psychiatric disorders, was left unanswered. This same resident’s baseline care plan documented use of an antidepressant for depression, and physician orders included monitoring for increased depression or suicidal ideation, tele-psychiatry services, and sertraline for depression. A PHQ-2 to 9 depression screening documented the resident feeling down, depressed, or hopeless, but the tool was incomplete and lacked a score. The Admission Director stated that major depressive disorder is a mental illness and that the PASRR was incorrect because it did not include this diagnosis. For a third resident, the face sheet showed no diagnosis or history of mental illness, yet the PASRR Level I Section C was left unanswered, and the Admission Director stated the screening was incorrect because the mental illness evaluation question was not answered. A fourth resident had documented diagnoses of major depressive disorder and anxiety disorder, but the PASRR Level I Section C was marked as "not identified" for mental illness, despite the baseline care plan and physician orders reflecting antidepressant use and monitoring for depression; the Admission Director believed the PASRR was correct and was unaware of the major depressive disorder diagnosis. A fifth resident had a diagnosis of anxiety disorder, and the MDS coded anxiety disorder as an active diagnosis, but the PASRR Level I Section C was marked as "not identified" for mental illness, and the Admission Director again believed the PASRR was correct and was unaware of the resident’s anxiety and major depressive disorder diagnoses. These findings show multiple instances where PASRR screenings were incomplete or inaccurately reflected residents’ mental health diagnoses.
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