Failure to Coordinate PASRR Reassessments After Significant Mental Health Changes
Penalty
Summary
The deficiency involves the facility’s failure to coordinate with the PASRR program and submit updated assessments when residents experienced significant mental health status changes. For one resident, a Level I PASRR completed at admission documented a primary neurocognitive disorder/dementia and use of Lexapro and Zyprexa for anxiety. Subsequently, the resident was care planned for antipsychotic use (Risperdal) related to frontotemporal dementia, delusions, and a history of psychosis. Over time, multiple new psychiatric diagnoses were added to the record, including major depressive disorder (MDD), delusional disorder with psychosis, unspecified dementia with psychosis, other specified behavioral and emotional disorders with onset in childhood/adolescence, and pseudobulbar affect. A quarterly MDS later documented active anxiety disorder, depression, psychotic disorder, and pseudobulbar affect. The State PASRR Authority later confirmed by email that the facility should submit a new PASRR assessment for a status change to include MDD as a new major diagnosis and to update the resident’s current mental status and diagnoses, but this had not been done. For a second resident, the clinical record showed admission with dementia, peripheral vascular disease, and diabetes mellitus, and a Level I PASRR that listed dementia, anxiety, and major depressive disorder, with trazodone and lorazepam prescribed and no known problematic behaviors. Later nursing documentation described increased issues evidenced by aggressiveness and physical altercations with staff. The resident was then diagnosed with delusional disorder and unspecified psychosis, and an antipsychotic (Seroquel) was ordered. A subsequent psychiatric note described the resident as difficult to manage, with no impulse control, poor response to redirection, and requiring medications, and a quarterly MDS documented anxiety, depression, and psychotic disorder. During interview, the DON stated that the last PASRR screening in the chart was the earlier Level I and confirmed there was no PASRR screening after that date, indicating the facility did not coordinate with PASRR for reassessment after the significant change in mental health status and diagnoses.
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