Failure to Complete and Update Accurate PASARR Screenings for Residents With Mental Health Diagnoses
Penalty
Summary
The deficiency involves the facility’s failure to ensure PASARR (Preadmission Screening and Resident Review) screenings and referrals were accurate, complete, and submitted according to professional standards for two residents. For one resident with diagnoses including long-term insulin use, Type 2 diabetes, stage 4 chronic kidney disease, and malnutrition, the hospital-submitted PASRR Level I did not reflect the resident’s history of anxiety or substance use disorder. The facility did not generate its own PASRR Level I, despite internal documentation identifying substance use disorder and elopement risk, and a mood/behavior care plan that referenced risk for mood or behavior changes. The admission MDS showed moderately impaired cognition but no history of anxiety or antianxiety medication use, even though the resident later had an order for an antianxiety medication and a quarterly MDS listed an active anxiety disorder diagnosis. For the second resident, who had an active diagnosis of bipolar disorder, the care plan documented the use of antipsychotic medications related to this diagnosis. However, the PASARR form completed for this resident did not include the bipolar disorder diagnosis or any evidence of ordered antipsychotic medication, and only three of the five PASARR review pages were completed. Subsequent clinical documentation, including a physician’s order for olanzapine for bipolar disorder and behaviors such as hallucinations and repeated requests for assistance, as well as a quarterly MDS indicating bipolar disorder and recent antipsychotic use, demonstrated that the PASARR information was incomplete and inconsistent with the resident’s actual condition and treatment. Interviews with facility staff further demonstrated gaps in the PASARR process. The Activities Director stated that a correct PASARR helps staff develop appropriate interventions but acknowledged reliance on her own assessment when the PASARR is inaccurate. The Social Services Director reported being new to the PASARR portal, lacking access for a period, and not having completed additional PASARR level screenings since assuming the role, despite acknowledging that a Level II should have been submitted for the resident with bipolar disorder once it was clear the stay would exceed 30 days. The DON confirmed that social services is responsible for PASARR completion, that staff were previously unaware of requirements such as updating Level I when a stay is expected to exceed 30 days, and that the diagnoses, care plans, and PASARR information for the residents did not match. The facility’s PASARR policy also lacked language addressing the requirement to update a Level I when an individual’s stay will exceed 30 days, as specified in the state Medicaid policy manual.
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