Failure to Initiate Level II PASRR After New Intellectual Disability Diagnosis
Penalty
Summary
The deficiency involves the facility’s failure to submit a Level II Preadmission Screening and Resident Review (PASRR) evaluation after a resident was diagnosed with an intellectual disability. A Level I PASRR completed in the hospital emergency room listed only diabetes and a history of Guillain-Barre Syndrome. The resident was admitted with these diagnoses, and upon admission the Medical Director completed a history and physical on the same day, adding a new diagnosis of intellectual disability based on information from the resident’s family representative and past medical records. This diagnosis was added to the resident’s diagnosis list in the facility’s medical record, and the resident’s subsequent MDS assessment showed the resident to be cognitively intact. However, there was no evidence in the medical record that a Level II PASRR request was ever submitted following the addition of the intellectual disability diagnosis. Interviews with staff revealed gaps in communication and tracking related to PASRR requirements. The Social Worker stated that hospitals typically completed PASRRs for residents admitted from the hospital and that she completed PASRRs for residents admitted from home, but she could not describe how she tracked PASRRs or how she became aware of new diagnoses. She later acknowledged that the resident had been diagnosed with an intellectual disability months earlier and that a Level II PASRR should have been submitted shortly after that diagnosis was added. The DON explained that new diagnoses were entered by the MDS nurse and then communicated at morning meetings so the Social Worker could initiate PASRRs as needed, and acknowledged that a Level II PASRR should have been completed for this resident but could not explain why it was not. The Medical Director confirmed that she added the intellectual disability diagnosis after reviewing family input and prior records, knew that such a diagnosis required a Level II PASRR, and stated she did not handle PASRR submissions. The Administrator also agreed that a Level II PASRR evaluation should have been submitted once the intellectual disability diagnosis was added.
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