Failure to Complete Required PASRR for Resident With Schizophrenia and Cognitive Impairment
Penalty
Summary
The facility failed to ensure that a required Preadmission Screening and Resident Review (PASRR) was properly completed for one resident with serious mental illness and cognitive impairment. The resident was admitted with diagnoses including a personal history of traumatic brain injury, opioid use, unspecified schizophrenia, and cognitive communication deficit. An MDS dated July 23, 2025 documented a BIMS score of 7, indicating severe cognitive impairment, and the care plan included an antipsychotic medication focus related to schizophrenia with hallucinations and delusions. A PASRR Level I completed on July 18, 2025 indicated an exemption or categorical determination (such as convalescent care, respite, terminal/severe illness, or primary dementia diagnosis), but the resident remained in the facility beyond the exempt stay. When the resident’s status changed from skilled nursing to long-term care, there was no evidence in the record of a new PASRR Level I or any PASRR Level II being completed or present in the documents section. SSD staff reported that a PASRR Level I should be done if a resident remains longer than 30 days and that diagnoses such as schizophrenia with related medications would typically lead to a Level II, but acknowledged that the resident was not submitted for another Level I when transitioning to long-term care. The facility’s own PASRR policy states that all applicants to a Medicaid-certified nursing facility must be evaluated for serious mental disorder and/or intellectual disability, be placed in the most appropriate setting, and receive needed services, but this process was not followed for this resident when they remained in the facility for long-term care.
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