The facility failed to complete a new level one PASRR for a resident after new SMI diagnoses were added to the chart. The resident’s record showed new diagnoses of dementia and major depressive disorder, but there was no evidence of a new PASRR assessment. The ED confirmed the facility did not complete the new level one PASRR when the diagnoses were added.
Failure to complete required PASRR Level I screenings after new MH diagnoses and mental status changes. Surveyors found that three residents had new psychiatric diagnoses and psychotropic medication changes, including antipsychotic, mood stabilizer, and anti-anxiety use, but the facility did not submit updated PASRR Level I screenings to determine whether Level II review was needed. Staff interviews confirmed the screenings were not completed despite prior PASRR outcomes stating that new information or changes required a new screen.
PASRR assessments were not re-evaluated for two residents when one assessment contained inaccurate psychiatric diagnoses and another resident later received new mental health diagnoses. The ED acknowledged that a new PASRR should have been completed for the inaccurate assessment and that the facility did not complete a new PASRR when the second resident’s diagnoses changed, despite policy requiring resident review when SMI, ID, or related conditions change.
A resident with bipolar disorder, anxiety, and ADD had a PASRR Level II that identified the need for individual therapy and medication monitoring with a psychiatrist or psych NP. The record contained no documentation that these mental health services were provided, and the DON confirmed there was no verification the PASRR recommendations were addressed; the BOM stated she scanned the PASRR into the EHR but did not review the recommendations.
PASRR screening was not updated after a resident received a new major mental health diagnosis. The resident had schizoaffective disorder, bipolar type, with behavioral symptoms documented in the care plan, but the SSD confirmed the last PASRR Level I submission did not include the diagnosis and no later screen was provided after the new diagnosis was received.
The facility failed to keep PASARR Level I screenings accurate and current for three residents when new mental health diagnoses and psychoactive medications were initiated. One resident’s PASARR omitted a PTSD diagnosis and an added antidepressant, despite documentation of PTSD on the MDS and care plan and a physician order for Pristiq. Another resident’s PASARR listed only depression and dementia, even after additional diagnoses such as borderline personality disorder, delusional disorder, and schizoaffective disorder were added and an antipsychotic (quetiapine) was ordered, with the MDS later reflecting psychotic disorder, schizophrenia, and depression with antipsychotic and antidepressant use. A third resident’s PASARR did not include a depression diagnosis or newly ordered escitalopram and lorazepam, although the admission MDS documented depression with antianxiety and antidepressant use. These omissions occurred despite facility policy requiring a new Level I review after significant mental status changes, including new mental health diagnoses or new psychotropic medications.
Failure to Re-evaluate PASRR After New Psychiatric Diagnosis: The facility did not ensure a resident's PASRR was re-evaluated after new psychotic disorder diagnoses were added to the chart. The resident had a prior PASRR Level I screen that found no SMI and no need for a Level II review, but the record lacked documentation of a new referral. The VP of Life Enrichment and the SSD both acknowledged the resident needed reassessment for possible Level II PASRR.
The facility failed to resubmit required PASARR screenings when residents experienced new or worsening mental health symptoms, started psychotropic medications, had psychotropic dose changes, or when short‑term PASARR approvals expired. One resident with dementia developed aggressive behaviors and was started on Valium and buspirone without a new PASARR reflecting the new anxiety diagnosis and medications. Another resident with depression, anxiety, and bipolar disorder had a Level II PASARR with a 90‑day approval that expired and later received buspirone for anxiety, but no updated PASARR was found. A third resident with a PASARR limited to a 60‑day approval for suspected intellectual disability remained without a resubmitted screen after the approval period. A fourth resident with depression and anxiety had increased Cymbalta dosing and multiple buspirone orders without a timely new PASARR. The Social Service Director acknowledged that PASARRs should have been resubmitted for these changes and that internal responsibility for monitoring PASARR timeliness was unclear.
A resident with diagnoses including PTSD, bipolar disorder, borderline personality disorder, anxiety disorder, and cognitive communication deficit had a PASARR Level II that did not show PTSD as a documented diagnosis, despite the DON stating the resident had PTSD. The SSD stated that a new PASARR Level I was needed when a new mental health diagnosis or mental health medication was added, but it was not completed for this resident, and the facility did not provide a PASARR policy prior to exit.
A resident with schizophrenia and anxiety did not have an accurate Level I PASARR after admission. The prior PASARR stated no Level II was needed because there was no serious mental illness and no mental health meds were prescribed, but the resident later had anxiety and was ordered Buspirone and Paroxetine. The DON stated no new Level I had been completed since admission, and the facility policy called for the Administrator and DON to monitor PASARR compliance through periodic audits.
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