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 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.
A resident with dementia and other mental health diagnoses was prescribed an antipsychotic medication and received a new diagnosis of psychotic disorder with delusions. Despite these changes, the facility did not complete an updated PASARR screening as required by policy, and the Social Service Director confirmed that a follow-up screen should have been implemented.
A resident with serious mental health diagnoses remained in the facility beyond the 60-day temporary PASARR approval period without a new Level I PASARR being completed, as required. Staff interviews confirmed the oversight, and facility policy mandates were not followed regarding timely rescreening for continued stay.
The facility did not accurately complete PASARR documentation for two residents, omitting mental health diagnoses and prescribed psychotropic medications such as aripiprazole, clonazepam, and zolpidem. Staff interviews confirmed the PASARRs were incomplete and that there was no facility policy related to PASARR.
Two residents with new psychiatric diagnoses were not promptly referred for required PASRR Level 1 or Level 2 assessments after their conditions changed and new psychotropic medications were started. The facility did not update PASRR screenings as required by policy following significant changes in mental health status.
A resident was prescribed new psychotropic medications and received new mental health diagnoses, but the facility did not complete an updated PASARR Level I assessment as required by policy. Interviews with the Executive Director and Social Service Director confirmed the oversight, despite facility policies mandating PASARR updates with significant changes in mental or physical status.
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