Failure to Update PASRR After New Serious Mental Illness Diagnoses
Penalty
Summary
The facility failed to conduct an appropriate PASRR evaluation for a resident who developed new diagnoses of serious mental illness after admission. The resident was admitted with diagnoses of Parkinson's disease and insomnia and later received additional diagnoses of dementia in other diseases classified elsewhere, Alzheimer's disease, major depressive disorder, and anxiety disorder. The resident’s face sheet reflected these new diagnoses, and the care plan documented a focus on antidepressant medication related to depression, anxiety, dementia, elopement due to cognitive impairment, and insomnia. Despite these changes, the resident did not have a PASRR Level II reflecting the new mental health diagnoses. Record review showed that the resident’s PASRR Level II determination dated April 4, 2024, documented an exclusion from PASRR due to no diagnosis and no Level of Care (LOC), and a subsequent PASRR Level I review dated February 5, 2025, indicated that no Level II was required due to resolved symptoms. The Minimum Data Set in iQIES indicated no PASRR with diagnosis, and the resident’s BIMS score was 14, indicating intact cognition. During interview, the Social Services Director stated that all residents must have a PASRR Level I on admission, that she reviews PASRR results and requests a Level II or new Level I if discrepancies are found, and acknowledged that the resident had a change in diagnosis requiring a Level II PASRR. The facility’s PASRR policy stated that residents will be screened prior to admission and upon any change in status for known or suspected serious mental illness, developmental disability, or intellectual disability.
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