San Antonio West: PASRR Screening Failures - TX

Federal inspectors found the facility had not submitted mandatory Pre-admission Screening and Resident Review evaluations to local authorities as required by federal law. These PASRR screenings determine whether residents with mental health conditions or intellectual disabilities need specialized rehabilitation services beyond standard nursing home care.

The administrator acknowledged during an April 10 interview that the facility's expectation was to send PASRR referrals to local authorities to determine if residents qualify for additional services. She told inspectors she wanted to ensure residents have access to benefits they qualify for, recognizing that the failure would result in "a loss of beneficial services."

The violation affected multiple residents, though inspectors classified the immediate harm as minimal.

PASRR evaluations are federally mandated for all nursing home residents with documented mental disorders or intellectual disabilities. The screenings help identify residents who need specialized mental health treatment, behavioral interventions, or intellectual disability services that typical nursing homes cannot provide.

When facilities skip these evaluations, residents may miss out on occupational therapy, specialized counseling, behavioral support programs, or even placement in more appropriate care settings. Some residents could qualify for additional Medicaid funding for enhanced services.

The facility's own policies, revised as recently as May 2025, explicitly required these screenings. The comprehensive care plan policy stated that specialized services or rehabilitation recommended through PASRR evaluations must be included in each resident's treatment plan.

Another policy from December 2016 specified that nursing and medical needs of individuals with mental disorders or intellectual disabilities "will be determined by coordination with the Medicaid Pre-admission Screening and Resident Review program to the extent practicable."

The policy further stated that potential residents with mental health conditions or intellectual disabilities should only be admitted after the state mental health agency determines through pre-admission screening that the individual requires the level of services the facility provides.

Despite these written policies, inspectors found the facility had not been following through with the required screenings and referrals.

The facility also maintained a policy requiring accurate assessment documentation for residents diagnosed with conditions like schizophrenia. This policy, revised in May 2025, required supportive documentation including evaluations of residents' physical, behavioral, mental and psychosocial status, as well as state PASRR evaluations.

The administrator told inspectors that once a determination was made about the level of harm from the missing screenings, she would update affected residents' care plans. However, the inspection report does not indicate when these updates would occur or how many residents were impacted by the delayed evaluations.

Federal regulations require nursing homes to conduct PASRR screenings before admission and whenever a resident's condition changes significantly. The evaluations help ensure residents receive appropriate care and aren't unnecessarily institutionalized when community-based services might better meet their needs.

The screening process involves detailed assessment of a resident's mental health history, current symptoms, medication effects, functional abilities, and behavioral patterns. State mental health agencies use this information to recommend specialized services or alternative placements.

Missing these evaluations can leave vulnerable residents without access to psychiatric services, behavioral therapy, or intellectual disability supports that could improve their quality of life. Some residents might qualify for community-based programs that allow them to live in less restrictive settings while still receiving needed care.

The inspection occurred on April 10, 2026, but the report does not specify how long the facility had been failing to complete required PASRR referrals or how many residents were affected by the missing screenings.

Full Inspection Report

The details above represent a summary of key findings. View the complete inspection report for San Antonio West Nursing and Rehabilitation from 2026-04-10 including all violations, facility responses, and corrective action plans.

Additional Resources

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