Failure to Request Level II PASRR Evaluations for Residents With New Mental Health Diagnoses
Penalty
Summary
The facility failed to submit required Level II Preadmission Screening and Resident Review (PASRR) evaluations for multiple residents who developed new mental health diagnoses after admission. Record review showed that four residents each had a PASRR Level I completed prior to admission, with explicit recommendations to resubmit paperwork for a Level II PASRR if a new mental health diagnosis was suspected or if there was a significant change in condition. For one resident, the quarterly MDS documented active diagnoses of psychotic disorder and major depressive disorder that were established after admission, yet there was no evidence of a Level II PASRR request. Another resident’s quarterly MDS reflected active diagnoses of anxiety disorder, major depressive disorder, and schizoaffective disorder, bipolar type, all diagnosed after admission, with no corresponding Level II PASRR request in the record. A third resident’s annual MDS documented active diagnoses of psychotic disorder, anxiety disorder, and major depressive disorder, all diagnosed after admission, without any evidence that a Level II PASRR evaluation had been requested. A fourth resident’s quarterly MDS showed active diagnoses of autism, psychotic disorder, and anxiety disorder, again with no documentation of a Level II PASRR request despite the pre-admission Level I instruction to resubmit if new mental health diagnoses occurred or there was a significant change. In interviews, the Social Worker stated she believed she was responsible for PASRR Level II paperwork but had not received training on when and how to complete and submit it, and she was unaware that Level II PASRR paperwork was required for new mental health diagnoses, significant changes, or expiring temporary Level II determinations. The Administrator confirmed that the Social Worker was responsible for PASRR paperwork, acknowledged the Social Worker had not received full PASRR training, and stated his understanding that Level II PASRR evaluations should be completed upon admission or readmission with a mental health diagnosis and with any new mental health diagnosis or change in condition, which had not occurred for the sampled residents.
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