| 84 |
LAS VEGAS POST ACUTE & REHABILITATION |
295006 |
2832 S. MARYLAND PARKWAY |
LAS VEGAS |
NV |
89109 |
2018-05-11 |
644 |
D |
1 |
1 |
QB3511 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, interview and record review, the facility failed to refer 2 out of 18 residents for pre-admission screening and resident review (PASARR) level two (Residents #19 and #59). Findings include: Resident #19 Resident #19 was admitted on [DATE], with [DIAGNOSES REDACTED]. On 05/10/18 at 8:30 AM, the resident indicated chronic pain issues and debility from [MEDICAL CONDITION] contributed to depression and anxiety. The resident indicated refusing activities and preferred to remain in bed. The resident verbalized being totally dependent on staff for activities of daily living (ADL). The clinical records documented the resident's PASARR level one screening completed on 05/18/18, did not require a PASSAR level two. Section I (Active Diagnoses) of the resident's Minimum Data Set ((MDS) dated [DATE], identified anxiety disorder ( ) and depression ( ) with no additional active psychiatric [DIAGNOSES REDACTED]. Section I (Active Diagnoses) of the resident's Minimum Data Set ((MDS) dated [DATE], identified anxiety disorder ( ), depression ( ) and major [MEDICAL CONDITION], single episode, severe with psychotic features (1800). Section I (Active Diagnoses) of the resident's Minimum Data Set ((MDS) dated [DATE], identified anxiety disorder ( ) and depression ( ) with no additional active psychiatric [DIAGNOSES REDACTED]. Section I (Active Diagnoses) of the resident's Minimum Data Set ((MDS) dated [DATE], identified anxiety disorder ( ) and depression ( ) and major [MEDICAL CONDITION], single episode, unspecified (1800). The [MEDICAL CONDITION] Summary Sheet for [MEDICATION NAME] 25 milligrams (mg) for [MEDICAL CONDITION], documented the number of behavior episodes of yelling: - 32 for the month of (MONTH) (YEAR) -90 for the month of (MONTH) (YEAR) -27 for the month of (MONTH) (YEAR) -9 for the month of (MONTH) (YEAR) -41 for the month of (MONTH) (YEAR) The [MEDICAL CONDITION] Summary Sheet for [MEDICATION NAME] 1.0 mg. for anxiety, documented the number of behavior episodes of increased restlessness: -65 episodes during 08/11/17 to 08/30/17 -93 episodes during 09/01/17 to 09/30/17 -26 episodes during 10/01/17 to 10/30/17 -100 episodes for the month of (MONTH) (YEAR) -32 episodes for the month of (MONTH) (YEAR) -34 episodes for the month of (MONTH) (YEAR) The [MEDICAL CONDITION] Summary Sheet for [MEDICATION NAME] 10 milligrams for anxiety, documented the number of behavior episodes of screaming and crying: - seven episodes during 08/26/17 to 08/31/17 -seven episodes during 09/01/17 to 09/30/17 - 23 episodes during 10/01/17 to 10/31/17 - 18 episodes in the month of (MONTH) (YEAR) - 59 episodes in the month of (MONTH) (YEAR) -8 episodes in the month of (MONTH) (YEAR) The [MEDICAL CONDITION] Summary Sheet for [MEDICATION NAME] 50 mgs. for anxiety, documented the number of behavior episodes of screaming: - 22 episodes during 09/24/17 -61 episodes during 10/01/17 -27 episodes for the month of (MONTH) (YEAR) -34 episodes for the month of (MONTH) (YEAR) The [MEDICAL CONDITION] Summary Sheet for Trazadone 100 mgs. for depression, documented the number of behavior episodes of inability to sleep: - 26 episodes during 08/16/17 to 08/31/17 - five episodes during 09/01/17 to 09/30/17 -two episodes during 10/01/17 to 10/30/17 -one episode for the month of (MONTH) (YEAR) - two episodes for the month of (MONTH) (YEAR) -eight episodes for the month of (MONTH) (YEAR) -17 episodes for the month of (MONTH) (YEAR) A psychiatric progress note dated 01/16/18, documented symptoms of continued depression which included a diminished interest in activities previously enjoyed, low mood, low energy and difficulty sleeping. The severity of symptoms were 8 out of 10 on a Likert scale (strength and intensity of experience) and occurred daily. A psychiatric progress note dated 01/16/18, documented symptoms of anxiety which included restlessness, sleep disturbances, fatigue and irritability. The severity of symptoms were 8 out of 10 on a Likert scale and occurred daily. Resident #59 Resident #59 was admitted on [DATE], with [DIAGNOSES REDACTED]. On 05/08/18 at 11:50 AM, the resident was alert, cooperative and responded appropriately to questions. Flat affect was evident. On 05/09/18 at 8:01 AM, the resident indicated she did not participate in activities and preferred to stay in bed most of the time. Flat affect was evident. The clinical records documented the resident's PASARR level one screening completed on 02/03/17, did not require a PASSAR level two. Section I (Active Diagnoses) of the resident's Minimum Data Set ((MDS) dated [DATE], identified anxiety disorder ( ), depression ( ) and [MEDICAL CONDITION] disorder, unspecified (1800). Section I (Active Diagnoses) of the resident's Minimum Data Set ((MDS) dated [DATE], identified anxiety disorder ( ) and depression ( ) with no additional active psychiatric [DIAGNOSES REDACTED]. Section I (Active Diagnoses) of the resident's Minimum Data Set ((MDS) dated [DATE], identified anxiety disorder ( ), depression ( ), [MEDICAL CONDITIONS] disease ( ) and [MEDICAL CONDITION] disorder, unspecified (1800). The [MEDICAL CONDITION] Summary Sheet for [MEDICATION NAME] 500 mg. for [MEDICAL CONDITION] disorder, documented the number of behavior episodes of resisting care: - 31 episodes from 10/01/18 to 10/31/17 -26 episodes for the month of (MONTH) (YEAR) -30 episodes for the month of (MONTH) (YEAR) -28 episodes for the month of (MONTH) (YEAR) -28 episodes for the month of (MONTH) (YEAR) The [MEDICAL CONDITION] Summary Sheet for [MEDICATION NAME] 20 mgs. for depression, documented the number of behavior episodes of sad mood : -three episodes from 03/23/17 to 03/31/17 -10 episodes from 04/01/17 to 04/30/17 -19 episodes from 05/01/17 to 05/31/17 -26 episodes from 06/01/17 to 06/30/17 -85 episodes from 07/01/17 to 07/31/17 -89 episodes from 08/01/17 to 08/31/17 -88 episodes from 09/01/17 to 09/30/17 - 65 episodes from 10/01/17 to 10/31/17 -89 episodes for the month of (MONTH) (YEAR) -one episode for the month of (MONTH) (YEAR) -19 episodes for the month of (MONTH) (YEAR) -62 episodes for the month of (MONTH) (YEAR) The [MEDICAL CONDITION] Summary Sheet for [MEDICATION NAME] 10 mgs for [MEDICAL CONDITION] disorder, documented the number of behavior episodes of verbalizations of disturbed thoughts : - two episodes from 07/01/17 to 07/31/17 -three episodes from 08/01/17 to 08/31/17 -10 episodes from 09/01/17 to 09/30/17 -34 episodes from 10/01/17 to 10/31/17 -30 episodes for the month of (MONTH) (YEAR) -31 episodes for the month of (MONTH) (YEAR) -29 episodes for the month of (MONTH) (YEAR) -16 episodes for the month of (MONTH) (YEAR) The [MEDICAL CONDITION] Summary Sheet for Klonopin 2 mgs for anxiety, documented the number of behavior episodes of verbal aggression: -one episode from 03/27/17 to 03/31/17 -8 episodes from 04/01/17 to 04/30/17 -103 episodes from 05/01/17 to 05/31/17 -140 episodes from 06/01/17 to 06/30/17 -30 episodes from 07/01/17 to 07/31/17 -8 episodes from 08/01/17 to 08/31/17 -59 episodes from 09/01/17 to 09/30/17 -28 episodes from 10/01/17 to 10/31/17 -43 episodes for the month of (MONTH) (YEAR) -28 episodes for the month of (MONTH) (YEAR) A psychiatric progress note date 02/05/18 documented, severe depressive symptoms which included low mood, low appetite, low energy, diminished interest in activities previously enjoyed and continued thoughts of death with no current plan. The severity of symptoms were 8 out of 10 on a Likert scale (strength and intensity of experience) and occurred daily. A psychiatric progress note date 02/05/18 documented, moderate tension, worry, fatigue, irritability and restlessness. The severity of symptoms were 8 out of 10 on a Likert scale occurred daily. On 05/11/18 at 11:02 AM, the Admissions representative indicated all residents were required to have a pre-admission screening and resident review (PASARR) level one. The Admissions representative interpreted the PASARR level one of Residents #19 and #59 as negative (a possible serious mental disorder or intellectual disability is not present). The Admissions representative explained the medicaid specialist would process applications for newly admitted residents as soon as possible in anticipation of turn over to medicaid. The Admissions representative communicated a level of care (L[NAME]) was necessary for the application. On 05/11/18 at 11:02 AM, the Director of Nursing (DON) indicated performing the L[NAME]'s whether the PASARR screening was negative (a possible serious mental disorder or intellectual disability was not present) or positive (a possible serious mental disorder or intellectual disability was present). The DON explained the Social Worker (SW) informed the state mental health authority (SMHA) and state intellectual disability authority (SIDA) once the L[NAME] was completed. On 05/11/18 at 11:02 AM, the SW indicated the facility did not refer adult residents to the SMHA who may be exhibiting new evidence or worsening symptoms of possible mental disorder. The SW indicated SMHA/SIDA representatives came to the facility on a quarterly basis. The SW indicated the SMHA/SIDA representatives would come with a list of residents who triggered on the SMHA/SIDA system. The SMHA/SIDA representatives evaluated these residents for possible need for PASARR level two. On 05/11/18 at 11:02 AM, the DON and SW confirmed Residents #19 and #59 were not evaluated by the SMHA/SIDA representatives during any of the agency's scheduled visits. The DON and SW confirmed the facility relied on the SMHA/SIDA representatives for identifying which residents needed to be referred for PASARR level two. The DON and SW did not refer Residents #19 and #59 for PASARR level two. The DON and SW confirmed Residents #19 and #59 did not have a PASARR level two. |
2020-09-01 |