A resident admitted with a primary diagnosis of Schizoaffective Disorder and an active diagnosis of Schizophrenia had a PASRR Level 1 that identified serious mental illness and indicated the need for a Level 2 referral, but the facility did not submit this referral to the state authority. The Social Service Director reported that she completed only the Level 1 and did not send the Level 2 to AHCCCS, despite her usual practice to do so for residents with Schizophrenia. The resident had intact cognition, was receiving antianxiety and antipsychotic medications, and had a behavioral care plan addressing verbal and physical aggression and exit-seeking behaviors, while the DON confirmed the resident was on a secured unit and followed by a psychiatric provider but lacked a Level 2 PASRR determination.
The facility failed to ensure accurate and updated Level I PASRR screenings for two residents with documented mental health diagnoses and psychotropic medication use. For one resident with schizoaffective disorder and anxiety, the Level I PASRR did not reflect the schizophrenia diagnosis despite its presence in the record and care plan, and the Social Services Director acknowledged the omission without knowing why it occurred. For another resident with anxiety, bipolar disorder with psychotic features, and depression, the Level I PASRR indicated no mental illness, symptoms, psychiatric history, or psychotropic medications, even though the MDS, care plans, and multiple psychotropic orders documented severe cognitive impairment, moderate depression, social isolation, and extensive use of psychotropic, antianxiety, and antidepressant medications. The Social Services Director reported no formal PASRR training and difficulty using the PASRR submission website, while the DON confirmed there was no in-house PASRR training, identified inaccurate PASRR completion, and noted the absence of a Level II PASRR despite diagnoses that would have warranted Level II submission under facility policy and state review expectations.
PASARR screenings were missing, incomplete, outdated, or not submitted for multiple residents with psychiatric diagnoses and related behaviors. Records showed absent or blank level I forms, outdated PASARRs from other facilities, and incomplete level II documentation for residents with schizoaffective disorder, schizophrenia, bipolar disorder, depression, anxiety, hallucinations, and psychotropic medication use. The SSW/DON interview confirmed that several screenings were not updated after stays exceeded 30 days and that some were not submitted for review.
A resident with generalized anxiety disorder, bipolar disorder, major depressive disorder, PTSD, muscle weakness, morbid obesity, and bariatric surgery status, and a BIMS score indicating cognitive intactness, remained in the facility for more than 30 days while receiving aripiprazole for PTSD and bipolar disorder. The only PASARR in the record was the hospital preadmission PASARR, which was null for serious mental illness and mental illness, and no new Level I PASARR was completed within 40 days as required by facility policy. Staff interviews showed that the social services clerk did not handle PASARRs, the regional LMSW reported the facility had only recently obtained information to submit PASARRs and that incorrect hospital PASARRs should be corrected, the MDS nurse relied on social services for PASARR review and did not check for Level II PASARRs, and the admissions coordinator stated that PASARRs are reviewed before admission by intake and a corporate auditor, yet no updated PASARR was present for this resident.
The facility failed to ensure PASARR screenings were accurate, complete, and updated for two residents with mental health and substance use-related conditions. One resident with diabetes, CKD, malnutrition, and documented substance use disorder and anxiety had a hospital-submitted PASRR Level I that omitted anxiety and substance use, and the facility did not generate its own Level I despite internal care plans and MDS data later reflecting an anxiety diagnosis and antianxiety medication orders. Another resident with an active bipolar disorder diagnosis and antipsychotic use had a PASARR form that omitted the bipolar diagnosis and antipsychotic therapy and was only partially completed, even though the MDS and physician orders documented bipolar disorder, hallucinations, and recent antipsychotic use. Staff interviews revealed that the SSD was new to the PASARR system, had not initiated additional PASARR screenings, and acknowledged that a Level II should have been requested for the resident with bipolar disorder, while the DON confirmed staff were previously unaware of requirements to update Level I when a stay would exceed 30 days and that the facility policy did not address this requirement.
A resident with a history of traumatic brain injury, opioid use, schizophrenia, and severe cognitive impairment remained in the facility after an initially exempt stay without a new PASRR Level I or any Level II being completed when the stay converted from skilled to LTC. Despite documented schizophrenia with hallucinations and delusions and ongoing antipsychotic use, no updated PASRR documentation was found in the record at the time of the status change, contrary to facility policy requiring evaluation of applicants for serious mental disorder and/or intellectual disability.
Multiple residents with documented mental health diagnoses and active psychotropic treatment did not receive accurate PASRR Level I screenings or required Level II referrals. In several cases, PASRR forms from referring facilities and the facility itself marked "no" history of serious mental illness, omitted diagnoses such as PTSD, bipolar disorder, borderline personality disorder, schizophrenia, and depression, and failed to reflect recent inpatient psychiatric hospitalization or suicidal ideation, despite these being clearly documented in the clinical record, MDS assessments, psychiatric notes, and care plans. Some PASRR forms also incorrectly indicated that residents were not on psychotropic medications, or left the Level II referral determination section blank, even though the same records listed multiple psychotropic agents for mood, anxiety, and psychotic disorders. No Level II referrals were found for these residents. In interviews, the Social Services Director acknowledged that PASRRs were inaccurate or incomplete, that Level II referrals should have been submitted but were not, that the facility is responsible for PASRR accuracy, and that she lacked clear training and consistent oversight on PASRR update requirements and tracking.
The facility did not complete or submit required PASARR Level II referrals for three residents with serious mental illness diagnoses, including schizophrenia, bipolar disorder, major depression, and anxiety disorder. These residents had documented cognitive status on the MDS, were prescribed psychotropic medications such as antipsychotics and antidepressants, and had PASARR forms completed by the admissions coordinator that listed their mental health diagnoses and medications. Despite this, no Level II referrals were made, even though the admissions coordinator later acknowledged that residents with diagnoses such as bipolar disorder should be referred and that facility policy requires all individuals with mental disorders or intellectual disability to be sent to the state for Level II determinations. The DON and administrator confirmed that PASARRs are expected to be conducted according to policy when residents have qualifying mental health conditions.
A resident with documented diagnoses of depression, anxiety disorder, bipolar disorder, schizoaffective disorder, psychotic disorder with hallucinations, and schizophrenia, and who was receiving antipsychotic and antidepressant medications, was not referred for a Level II PASRR evaluation. Care plans identified psychosocial issues related to multiple mental health conditions and included an intervention to initiate referrals as needed. Multiple Level I PASRR screenings, completed by the hospital and later in the facility, listed only anxiety and depression and indicated no Level II referral was necessary, despite the clinical record showing serious mental illness. Staff interviews revealed that the case manager did not perform PASRR screenings, the resident relations manager handled PASRRs but did not initiate a Level II referral for this resident, and the administrator confirmed there was no Level II PASRR referral, contrary to facility policy requiring such referrals when potential mental illness is present.
A resident with a history of mental health and substance use disorders experienced multiple behavioral incidents, including altercations and suspected intoxication, but the facility failed to update the PASRR to reflect these changes or review recommendations as required. Staff interviews and documentation confirmed the PASRR remained outdated and inaccurate, listing discontinued medications and omitting current behavioral concerns.
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