Failure to Implement PASARR Level II Therapy Recommendations for Two Residents
Penalty
Summary
The deficiency involves the facility’s failure to incorporate PASARR Level II determinations and PASARR evaluation report recommendations into resident assessments, care planning, and transitions of care for two residents. For one resident, a male with developmental disorders of speech and language, lack of coordination, muscle wasting and atrophy, and upper extremity impairment, the PASARR PCSP meeting requested specialized assessments and ongoing services in OT, PT, and ST. Physician orders also authorized OT, PT, and ST to evaluate and treat as indicated. Although a speech therapy evaluation and plan of treatment were completed, the resident did not receive a PT evaluation or PT services, and he was not evaluated for OT services despite the PASARR and physician orders. For the second resident, a male with cellulitis of the lower limb, intellectual disabilities, dysphagia, parkinsonism, cognitive communication deficit, muscle wasting and atrophy of both thighs, a left hand contracture, and schizophrenia, the PASARR PCSP meeting documented ongoing specialized OT, new PT, and discontinued ST. Physician orders authorized OT, PT, and ST to evaluate and treat as indicated, and an OT evaluation and plan of treatment were completed with findings of decreased activity tolerance, reduced independence with self-care, and upper extremity weakness. However, the PT evaluation on file predated the most recent PASARR request for services, and no new PT evaluation was completed in response to the PCSP’s request for new PT services. Multiple staff interviews revealed confusion and lack of clarity regarding responsibility for initiating and submitting therapy referrals and PASARR-related documentation into the electronic portal. An LVN stated that PT services for the second resident were not sent and that the first resident refused services, and she was unsure who was responsible for ensuring referrals were sent. The DOR reported that the first resident was not evaluated for PT or OT and that the second resident did not receive PT because of his physical condition, and acknowledged that if no referral is initiated, evaluations are not completed. The DON and the Administrator both indicated they were unaware that the two residents had not received all PASARR-approved services and described that the MDS/care management team was responsible for entering and submitting requests electronically. An RN stated there was no facility policy specific to PASARR Level II and that missing information in the electronic portal had been identified during PASARR Level II audits.
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