Failure to Implement PASARR-Recommended Customized Wheelchair Service
Penalty
Summary
The deficiency involves the facility’s failure to incorporate PASARR Level II recommendations into a resident’s assessment, care planning, and transitions of care, specifically the provision of a customized manual wheelchair (CMWC) as a specialized service. The resident was an adult male with cerebral palsy, dementia, and speech disturbances, with a BIMS score of 03 indicating severe cognitive impairment and dependence on staff for ADLs. His care plan included requirements to complete and submit a new PL1 for any readmission or change of condition, notify the local authority and therapy department of PASARR-positive status, and hold an IDT meeting within 14 days of admission. A PASRR care plan meeting and PASRR Comprehensive Service Plan Form dated 08/06/25 documented that the IDT, including PASRR representatives, agreed the resident would receive habilitation coordination, independent living skills training, and a customized manual wheelchair as a new specialized service. Despite this agreement, the facility did not successfully submit the necessary NFSS request for the CMWC through the Simple LTC portal within the PASARR time frame. Portal records dated 08/15/25 and 11/07/25 showed the forms for the customized wheelchair were marked "form not accepted," and no NFSS was submitted. During observation, the resident was seen in a non-customized wheelchair, leaning to the left with his left hand dangling out of the chair, and attempts to interview him using a language line interpreter were unsuccessful due to unclear speech. The PTA reported that she recommended the CMWC at the PASRR meeting, the PASRR coordinator agreed, the wheelchair company assessed and measured the resident, and the physician signed the paperwork, but she was informed the NFSS was not accepted due to a discrepancy with the resident’s date of birth. Interviews with the MDS coordinator, DON, and business office manager revealed that the NFSS submission was rejected because of conflicting Social Security and date-of-birth information, and that the issue had been referred to the business office and corporate without resolution. The business office manager stated that the Social Security office had an older, incorrect date of birth that had become official and that she contacted an HHSC eligibility services clerk, who confirmed the birth date change in early August 2025. The PASRR staff reported that the facility did not reach out to PASARR support for assistance and explained that the facility should have inactivated the rejected PO1 and submitted a new one with the correct date of birth. The MDS coordinator stated that the head office changed the date on the declined PO1 but refused to cancel and resubmit it due to billing concerns, and she declined to contact PASARR support directly. The facility was unable to provide a PASRR policy when requested at entrance and exit interviews.
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