Failure to Initiate Required PASRR Level II Evaluations for Residents With Mental Illness
Penalty
Summary
The deficiency involves the facility’s failure to initiate required PASRR Level II evaluations and updated Level I screenings for residents with identified or newly developed mental illness diagnoses. For one resident, an initial OBRA Level I screening completed shortly after admission indicated no reasonable basis to suspect mental illness or developmental disability. However, over time this resident developed multiple psychiatric diagnoses, including dementia with behavioral disturbance, major depressive disorder, unspecified psychosis, and depression, and experienced discharges and readmissions. Despite these new psychiatric diagnoses and readmissions, the Social Service Coordinator confirmed that no additional PASRR evaluations were completed, and the Social Service Director stated that a new Level I should have been submitted before readmission but was not. Another resident had a PASRR Level I screen that resulted in a referral for a Level II onsite evaluation, and the subsequent Level II outcome determined the resident was excluded from PASRR with no qualifying diagnosis and no level of care, with instructions that no further Level II screening was required unless there was a significant change in status suggesting serious mental illness, intellectual disability, or developmental disability. After this determination, the resident was diagnosed with post-traumatic stress disorder, anxiety disorder, unspecified psychosis, recurrent mild major depressive disorder, and bipolar disorder, and was prescribed multiple psychotropic medications including duloxetine, diazepam, olanzapine, and quetiapine. The Social Service Coordinator acknowledged that no updated Level I screening or referral to the state-designated PASRR authority was made after these new mental health diagnoses were identified and stated that this referral was missed. A third resident had a PASRR Level I pre-screening completed prior to admission, which indicated a reasonable basis to suspect the presence of a developmental disability or mental illness. Subsequent record review showed that this resident later received additional psychiatric diagnoses, including bipolar disorder and unspecified psychosis, and was prescribed medications such as Ativan, buspirone, and duloxetine. The Social Service Coordinator explained that the interdisciplinary team discusses new diagnoses in daily morning meetings and that once a new mental illness diagnosis is identified, a PASRR Level II is required and is the responsibility of Social Services. However, the Coordinator confirmed that no PASRR Level II screening had been completed for this resident, and the Social Service Director confirmed there was no Level II on file. The facility’s admission criteria policy requires Level I PASRR screening for all admissions and readmissions and referral for Level II when criteria for mental disorder, intellectual disability, or related condition are met, but this process was not followed for these residents.
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