F0745

D

Failure to Provide Required Permanency Planning Services for a Resident Under 22

Fort Worth, Texas Survey Completed on 01-12-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide medically related social services, specifically permanency planning services, to a resident under the age of 22 as required by Texas regulations. The resident was a young adult with a history of diffuse traumatic brain injury with loss of consciousness, ventilator dependence via tracheostomy, severe mobility limitations, GERD, generalized anxiety disorder, and depression. Her MDS reflected severe cognitive impairment, no speech, dependence on staff for all ADLs with two-person assist, risk for dehydration and shortness of breath, need for parenteral/IV feeding and feeding tube, risk for pressure ulcers, and multiple special treatments including oxygen, suctioning, tracheostomy care, invasive mechanical ventilation, and IV access. The care plan and MD orders documented extensive medical and nursing needs, including anticoagulant therapy, seizure disorder, bowel incontinence, enhanced barrier precautions, feeding tube management, and tracheostomy care.

Despite the resident’s age and the Texas requirement that permanency planning be completed every six months for individuals under 22 residing in nursing facilities, the facility did not ensure that permanency planning was initiated or supported. The Permanency Planning Contractor (PPC) sent emails to the facility social worker (SW) on multiple dates with a provider letter explaining permanency planning requirements, a blank Form 2437 (Notification of Nursing Facility Admission of Person Under Age 22), and information that permanency planning is mandated under Texas Administrative Code. The PPC reported requesting records on several occasions and informing the SW that records were required within three days. The PPC also stated that a negative PASRR result would not prevent permanency planning services. However, the facility’s Clinical Director (CD) stated that permanency plans were only completed for PASRR-positive residents under age 22 and that, because the resident’s PASRR evaluation was negative, no further action was taken.

The SW reported being unfamiliar with the term “permanency planning” and stated that when contacted by the PPC for the resident’s care files and related documents, she questioned the legitimacy of the request, was concerned about HIPAA and confidentiality, and did not feel comfortable providing information. She indicated that the PPC could not provide sufficient information about the resident’s relation and purpose of the request, and she did not document the contact, did not forward the emails to the DON or administrator, and did not contact HHSC, the PPC, or a PPC superior to verify the request. The SW initially denied receiving emails from the PPC, and it was only after the surveyor requested supporting documentation that the SW produced the email correspondence. Interviews also revealed that the DON and CD could not provide a facility policy on permanency planning, and both reported that no such policy existed. As a result of these actions and inactions—misunderstanding of PASRR’s role, failure to recognize and act on permanency planning requirements for a resident under 22, failure to respond to PPC requests, and lack of policy guidance—the facility did not provide the required medically related social services related to permanency planning for this resident.

The resident remained non-interviewable during survey observations due to her traumatic brain injury, but she was observed awake in bed, ventilator-dependent, with clean equipment and environment, and able to visually track the surveyor. The record review confirmed that the resident had been in the facility for several months, and the SW’s own note documented initial contact from an individual stating the resident had been flagged by the state for permanency placement assistance due to age. The SW’s note also reflected her discomfort with the call, her belief that the caller’s identification as a state representative was questionable, and her decision not to proceed without consulting the family or administration, yet she did not follow through with leadership or regulatory contacts. The combination of the facility’s lack of a permanency planning policy, the SW’s lack of knowledge and failure to act on multiple PPC contacts, and the CD’s reliance on PASRR status instead of permanency planning regulations led directly to the failure to assist this under-22 resident in obtaining permanency planning resources and services as required.

Additionally, the DON reported that she had completed the initial PASRR at admission, determined the resident was positive, and submitted the 2401 form to HHSC, after which a QIDP evaluation concluded the resident did not qualify for PASRR services. The DON stated that the family was informed of these PASRR results and agreed to services for the resident, and that the SW was assigned to contact the provider about the records request. However, the SW did not complete this assignment and did not engage with the PPC to move forward with permanency planning. The surveyor’s review of the SW’s personnel file showed that she had been hired earlier in the year at a sister facility and transferred to the current facility shortly before the PPC contacts, and there was no evidence that she had prior training on permanency planning before the in-service that occurred after the PPC’s initial outreach. The absence of a facility policy, combined with the SW’s inaction and the CD’s misunderstanding of regulatory triggers, resulted in the resident not receiving the medically related social services necessary to support permanency planning.