Failure to Offer or Document Pneumococcal Vaccination
Penalty
Summary
The facility failed to ensure that the pneumococcal (PCV20) vaccine was offered or administered to a resident as recommended by CDC guidelines. Review of the resident's records, including the facesheet, admission MDS, physician's orders, and care plan, showed no documentation that the PCV20 vaccine was offered or refused. The resident had a history of heart failure, muscle weakness, fatigue, obesity, and a past history of pneumonia, and required assistance with self-care due to weakness and visual impairment. During interview, the DON confirmed that the vaccine should have been offered to all residents and was unable to explain why this was missed for this resident. The facility's policy, updated in February 2024, states that all residents should be offered pneumococcal vaccines in accordance with CDC recommendations.