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F0887
D

Failure to Administer COVID-19 Vaccine After Consent

Weyauwega, Wisconsin Survey Completed on 04-17-2025

Penalty

5 days payment denial
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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

A resident with chronic obstructive pulmonary disease (COPD) and moderate cognitive impairment, as indicated by a Brief Interview for Mental Status (BIMS) score of 10 out of 15, was admitted to the facility with an activated Power of Attorney for Healthcare (POAHC) responsible for healthcare decisions. The POAHC provided signed consent for the resident to receive a COVID-19 vaccine, as documented in an undated Authorization and Release for COVID-19 Vaccine form. Despite this consent, the facility did not administer the COVID-19 vaccine to the resident, and there was no documentation in the medical record indicating that the vaccine was given. During an interview, the Infection Preventionist confirmed that the resident should have received the vaccine but did not.

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