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.
The facility failed to ensure a new PASRR level 1 was completed when new serious mental health diagnoses were added for two residents. One resident had psychotic disorder added to the chart after the most recent PASRR, and another had major depressive disorder with psychotic symptoms added after the most recent PASRR. The ED and DON confirmed the existing PASRRs were completed before those diagnoses were added, and the facility record lacked documentation of a new referral to the state-designated mental health authority.
A resident with bipolar disorder, hoarding disorder, OCD, and PTSD did not have a new PASARR Level I completed after new mental health diagnoses and psychotropic medications were added. The record showed prior PASARR findings of no mental health disorder or meds, while the MAR and care plan documented ongoing psychotropic use and behavioral concerns. The SSD confirmed no updated PASARR Level I was on file.
A resident’s PASSAR Level I screen did not include current mental health diagnoses or accurate mental health medication information. The resident had documented depression, anxiety, insomnia, and dementia, and was receiving buspirone, trazodone, and duloxetine, but the screen listed no known mental health diagnoses and recorded the medication diagnoses as unknown. Facility leaders later noted that several PASSAR Level I screenings had not been updated.
A resident with multiple medical and behavioral health diagnoses, including depression, vascular dementia, PTSD, and an adjustment disorder with anxiety, was started on diazepam twice daily for anxiety without a timely PASARR Level I screen. The PASARR assessment related to the new anxiety diagnosis and new antianxiety medication was not completed until after the survey had begun, despite the Administrator’s acknowledgement that a new Level I is required when a new psychotropic medication or mental health diagnosis is added and facility policy directing contact with the PASARR office for such behavioral health conditions.
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