Resident #1 qualified for specialized services through the state's Preadmission and Screening Resident Review program, which identifies nursing home residents with intellectual disabilities who need additional support. After an interdisciplinary team meeting determined he needed a custom manual wheelchair and occupational and physical therapy, the facility had 20 business days to request approval from state health services.
They missed the deadline.
"The facility was given an additional specific timeframe to submit the NFSS request, but the facility did not meet that timeframe in addition to the previous 20 business days that were allowed," the Regional LIDDA Director told inspectors on August 29.
The resident's current wheelchair was missing a brake on one side, though he told inspectors it was "functioning fine" and he was aware he could get a new one. He said he was waiting to get it but wasn't interested in doing therapy.
The facility's own policy, revised in March 2023, required staff to "initiate the request for specialized services within 20 business days of the IDT/PCSP meeting." The policy warned that failure to process information timely could result in residents missing services they were qualified for.
That's exactly what happened.
The Regional LIDDA Director explained the facility submitted partial information on May 20, which state health services processed three days later. But the submission lacked critical documentation for physical and occupational therapy services under the supplier acknowledgment section.
"All the required documentation was not submitted under the supplier acknowledgment tab and was lacking documentation for PT and OT services, which caused the process to be delayed beyond the 20-day timeline," she said.
The director emphasized that facilities bear responsibility for monitoring the online portal process. "It was the responsibility of the facility to follow-up on the portal process and assure timely submission and acceptance of documentation."
At Windmill Village, that responsibility fell to the MDS Nurse, who was supposed to enter PASRR information into the state portal and report any issues to the administrator. The administrator acknowledged this system during her interview with inspectors.
The Director of Rehabilitation wasn't in his position when the original team meeting occurred. He told inspectors the occupational therapy evaluation had been completed and the custom manual wheelchair had been measured and ordered, but was still awaiting PASRR approval.
Federal PASRR requirements exist to ensure nursing home residents with intellectual disabilities, developmental disabilities, or mental illness receive appropriate specialized services rather than just basic nursing care. The program prevents inappropriate institutionalization and guarantees access to rehabilitation services that could improve residents' quality of life.
For Resident #1, the delays meant continuing to use a wheelchair with a missing brake while waiting for the custom equipment his care team determined he needed. The therapy services recommended by the interdisciplinary team remained unavailable.
The facility's policy manual spelled out the stakes clearly. PASRR rules exist "to ensure they are properly placed, whether in community or in a Nursing Facility (NF) and to ensure they receive the services they require for their MI, or ID/DD."
When facilities fail to follow through on specialized service requests, residents lose access to care designed specifically for their disabilities. The administrator's own words captured the consequence: residents "may miss services that they were qualified for."
State inspectors found the facility violated federal requirements for ensuring residents receive necessary specialized services. The violation received a minimal harm rating, affecting few residents.
But for Resident #1, the bureaucratic failure meant real delays in getting equipment and services his care team said he needed. His wheelchair still had only one working brake when inspectors arrived in late August, months after the original recommendation.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Windmill Village Rehabilitation & Care Center from 2025-08-29 including all violations, facility responses, and corrective action plans.
Additional Resources
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