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F0883
E

Failure to Offer and Administer Pneumococcal Immunizations to Eligible Residents

Webster, Massachusetts Survey Completed on 04-10-2025

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 pneumococcal immunizations were properly offered and administered to eligible residents, as evidenced by record reviews and staff interviews. Specifically, one resident was not offered an updated pneumococcal vaccine upon admission, and there was no documentation that the resident or their representative had been educated about or offered the vaccine, despite the resident not being up-to-date with current recommendations. Another resident, who had previously received PCV13 and had provided signed consent for the updated PCV20 vaccine, did not have any evidence in their clinical record that the vaccine was administered or that it was medically contraindicated. Additionally, an audit revealed that 75 residents in the facility were eligible for pneumococcal immunization and not up-to-date, yet none had been offered the updated vaccine. The Infection Preventionist in Training confirmed that there was no tracking system in place for pneumococcal immunizations when she began her role, and that although some vaccine supply was available, no eligible residents had been offered or administered the updated immunization at the time of the audit.

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