**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview and record review, the facility failed to refer a resident for a level II Preadmission Screening and Resident Review (PASRR) when diagnosed with a newly evident serious mental illness for 1 of 2 residents reviewed for PASRR (Residents #12). Findings included: Resident #12 was admitted to the facility on [DATE] with no diagnosis of mental health disorders and a level I PASRR. Review of Resident #12 ' s medical record diagnosis sheet revealed newly evident mental diagnoses were identified on the following onset dates: anxiety disorder onset date of 3/16/21 and major depressive disorder onset date of 5/20/21. Review of Resident #12 ' s Annual Minimum Data Set (MDS) dated [DATE] indicated Resident #12 was cognitively intact. The resident ' s current active diagnoses included, in part, anxiety disorder and depression. Resident #12 received antidepressants. The MDS indicated the resident had a level I PASRR. In an interview on 4/21/22 at 11:00 AM with the Minimum Data Set Nurse #1 (MDS Nurse #1) she stated when a resident was newly diagnosed with a mental illness the resident needed to be evaluated for a level II PASRR. She confirmed a referral was not made for a reevaluation and acknowledged there should have been a resubmission for a PASRR level II evaluation for Resident #12 when the newly evident mental health diagnoses were identified. She also stated it was a misunderstanding of when and why to resubmit the data for the level II PASRR when a newly diagnosed mental health diagnosis was identified. She clarified it was the MDS Nurse that notifies Social Work to resubmit the information and the MDS Nurse failed to make the Social Worker aware of the changes. An interview was conducted with the facility ' s Administrator on 4/21/22 at 11:54 AM. He expressed the PASRR information was expected to be resubmitted immediately by the MDS Nurse to the Social Worker so follow up documentation could be sent forward for reevaluation. He expressed all residents should be reviewed and screened for any needed level II PASRR assessments when mental health changes occur.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, staff interviews, and record reviews, the facility failed to provide a resident's tube feeding in accordance with the physician's order for 1 of 1 resident (Resident #17) reviewed for tube feeding. Findings included: Resident #7 was admitted to the facility on [DATE] with diagnoses that included dysphagia with a feeding tube. Her quarterly Minimum Data Set (MDS) dated [DATE] indicated severe cognitive impairment. She received over half of her daily calories and fluids from her tube feeding (TF). Review of physician's orders revealed an order for Glucerna 1.2 at 74 milliliters (ml) per hour to begin at 5:00 PM and stop at 10:00 AM (total 1258 ml per day). An observation was made on 4/19/22 at 8:40 AM of Resident #17's TF pump turned off with the formula bottle removed from the room. An observation was made on 4/20/22 at 8:40 AM of Resident #17's TF pump turned off with the formula bottle removed from the room. During an interview on 4/20/22 at 8:45 AM, Nurse #1 revealed that Resident #7 received her TF from 5:00 PM to between 8-10 AM. She indicated that when the bottle ran out, she would turn the pump off. Nurse #1 confirmed the order was to stop the TF at 10:00 AM. During an interview on 4/20/22 at 2:10 PM, the Registered Dietitian (RD) revealed that Resident #7 should receive her TF over 17 hours starting at 5:00 PM and ending at 10:00 AM. She indicated it should not be turned off early. She further revealed Resident #7 had not lost weight. During an interview on 4/20/22 at 4:35 PM, the Regional Clinical Director of Operations revealed staff should be using a 1500 ml bottle of tube feeding formula and turning it off per order. An observation was made on 4/20/22 at 4:40 PM with assistance from the Assistant Director of Nursing (DON) of Resident #17's TF pump history. The pump indicated Resident #7 had received 1027 ml of TF over the past 24 hours. During an interview on 4/21/22 at 8:25 AM, the DON indicated that Nurse #1 should have followed the physician's order for Resident #7's TF. She confirmed Resident #7 did not get the full TF for the past two days. During an interview on 4/21/22 at 8:30 AM, the Administrator revealed the nurse should have followed the physician's order to ensure Resident #7 received her TF.