F0644

E

Failure to Resubmit PASARR for Residents With Mental Health Changes and Psychotropic Medication Adjustments

Tipton, Indiana Survey Completed on 03-26-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to ensure required Preadmission Screening and Resident Review (PASARR) updates and resubmissions were completed when residents experienced changes in mental health status, psychotropic medication use, or when short-term approvals expired. For one resident with Alzheimer’s disease and dementia, the hospital discharge documentation did not list anxiety or psychotropic medications, and the initial Level I PASARR identified only dementia with a requirement for a Level II evaluation and resubmission if changes occurred. After admission, this resident developed significant new behaviors, including attempts to force open a fire exit door, yelling, cursing, threatening to hit staff, and physically hitting and pushing staff. In response, the physician ordered multiple psychotropic medications, including Valium and buspirone, for anxiety and agitation, but no new PASARR Level I screen reflecting the new anxiety diagnosis and psychotropic medications was found in the medical record.

Another resident with major depressive disorder, anxiety disorder, and bipolar disorder had a Level I PASARR that identified Seroquel use and required a Level II evaluation. The Level II PASARR granted a 90‑day short‑term approval, with a specified end date, but there was no evidence in the clinical record that a new Level II PASARR was completed before the approval period ended. During this time, a new physician’s order was written for buspirone for anxiety, yet no PASARR documentation including this new psychotropic medication was located. A third resident, with diagnoses including mild cognitive impairment, hypertension, and type 2 diabetes, had a Level I PASARR with a 60‑day approval related to a suspected or confirmed intellectual disability, which required a new Level I screen if the resident remained beyond the approved days. The record did not contain a resubmitted PASARR after the 60‑day approval period expired.

For a fourth resident with severe recurrent major depressive disorder, anxiety disorder, and chronic pain, the PASARR documented depression, anxiety, and treatment with Cymbalta. Subsequent physician orders showed an increased Cymbalta dosage and multiple changes in buspirone dosing over time, with buspirone ultimately remaining on the scheduled medication list along with Cymbalta. Despite these changes in psychotropic medication regimen, there was no evidence of a timely new PASARR screen when the new medication was started or when the regimen changed. Interviews with the Social Service Director confirmed that new PASARR submissions were expected when psychotropic medications were added, when short‑term approvals were ending, or when new mental health diagnoses were made, and acknowledged that the affected residents’ PASARRs were not resubmitted as required and that responsibility for timely PASARR submission had not been clearly established within the facility.