Inspection·April 3, 2025

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to refer a resident with newly evident or possible serious mental disorder, intellectual disability, or a related condition for level II resident review for 1 of 8 residents (Resident #1) reviewed for resident assessment. The facility failed to ensure Resident #1's PASRR Level I screening reflected her mental illness diagnosis. This failure could place residents at risk of not receiving specialized services for their mental illness. Findings included: Record review of Resident #1's admission Record dated 4/3/25 revealed a [AGE] year-old female who readmitted to the facility on [DATE]. Her diagnoses included schizoaffective disorder, bipolar type (a mental health condition that is marked by a mix of schizophrenia symptoms, such as hallucinations and delusions, and mood disorder symptoms, such as depression, mania and a milder form of mania called hypomania), anxiety disorder, depression and major depressive disorder severe with psychotic symptoms. Record review of Resident #1's discharge-return anticipated MDS assessment, dated 3/19/25 revealed her cognitive skills for daily decision making were moderately impaired. Record review of Resident #1's care plan dated 4/2/25 indicated she used antidepressant medication related to depression, anxiety, schizoaffective disorder, bipolar type, and major depressive disorder recurrent severe with psychotic symptoms. Record review of Resident #1's PASRR Level I screening dated 8/28/23 indicated there was no evidence or an indicator that the resident had a mental illness. Resident #1 did not have a primary diagnosis of dementia. In an interview on 4/2/25 at 3:49 p.m. the MDS nurse said Resident #1 was positive for mental illness and did not have a dementia diagnosis. She said the (inaccurate) PASRR should have been caught during admission and she would submit another PL1 screening, She said she should have completed an audit of all residents with a schizo diagnosis. She said the purpose of the PASRR screening was to ensure the resident got adequate care and help to go out into (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 675365 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675365 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pasadena Post Acute 4006 Vista Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)