Failure to Request Level II PASRR Evaluations After New Mental Health Diagnoses
Penalty
Summary
The deficiency involves the facility’s failure to submit required Level II Preadmission Screening and Resident Review (PASRR) evaluations for multiple residents who developed new or additional mental health diagnoses after admission. For each of the five affected residents, a PASRR Level I had been completed prior to admission with explicit recommendations to resubmit paperwork for a Level II evaluation if a new mental health diagnosis was suspected or if there was a significant change in condition. Despite these instructions, the medical records for these residents contained no evidence that Level II PASRR requests were submitted after new mental health diagnoses were made and documented. One resident was initially admitted with medical diagnoses such as hypertension and diabetes and later readmitted with new diagnoses of post-traumatic stress disorder (PTSD) and major depressive disorder, which were documented as active on the MDS, yet no Level II PASRR request was found. Another resident was admitted with Parkinson’s disease, heart failure, and multiple mental health conditions including anxiety disorder, major depressive disorder, and a psychotic disorder with hallucinations; these diagnoses were active on the MDS, and the resident had received antidepressant and antipsychotic medications in the prior seven days, but again there was no evidence of a Level II PASRR request. A third resident, originally admitted with heart failure, diabetes, and seizure disorder, was later readmitted with new diagnoses of anxiety disorder, major depressive disorder, and psychotic disorder with delusions, all active on the MDS, without any corresponding Level II PASRR submission. Two additional residents had similar patterns of new or additional mental health diagnoses without subsequent Level II PASRR requests. One was readmitted with a new diagnosis of major depressive disorder, which was active on the MDS, and another, long-term resident with dementia and hypertension was readmitted with new diagnoses of major depressive disorder, PTSD, and anxiety disorder, all active on the MDS, yet neither had documentation of a Level II PASRR request. Interviews with the social worker and the administrator confirmed that the social worker was responsible for completing and submitting PASRR paperwork, that she had only recently received training, and that they were unaware these residents lacked Level II evaluations despite the presence of qualifying mental health diagnoses and prior Level I instructions to resubmit for Level II upon such changes.
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