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F0883
D

Failure to Administer Pneumococcal Vaccine

Williamsport, Pennsylvania Survey Completed on 12-20-2024

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure that a resident received the pneumococcal immunization, as required. Resident 5 was admitted to the facility on December 3, 2018, and a review of their immunization history showed no evidence of receiving the recommended pneumococcal vaccine. Although a Pneumococcal Immunization Informed Consent was signed by Resident 5's responsible party on November 18, 2024, granting permission for the vaccination, there was no documented evidence that the facility offered or administered the pneumococcal immunization to the resident after obtaining consent. During an interview with the Nursing Home Administrator on December 20, 2024, it was confirmed that the facility did not have documentation showing that the pneumococcal immunization was offered to Resident 5 following the consent. This deficiency was noted in the context of a previous citation for similar issues related to nursing services.

Plan Of Correction

1. Resident 5 refused to have his pneumococcal vaccine administered and it was documented. 2. Audit will be completed of current residents to ensure those residents who consented to receive the pneumococcal vaccine have received it or documented refusal. 3. Education will be provided to the Infection Preventionist on ensuring those residents who consent to the pneumococcal vaccine receive it. 4. Random audits will be completed weekly for 4 weeks then monthly for 2 months to ensure residents who have newly consented to receiving the pneumococcal vaccine are offered it. Results of audits will be presented at the Quality Assurance Performance Improvement Committee meeting for review and recommendations.

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