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F0887
E

Failure to Document COVID-19 Vaccination Status and Informed Declinations

Holton, Kansas Survey Completed on 08-26-2025

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 offer or obtain informed declinations or a physician-documented contraindication for the COVID-19 vaccination for three residents. Record reviews for these residents showed no documentation in the electronic medical record (EMR) under the Immunization tab indicating that the COVID-19 vaccine was offered, declined, historically administered, or that a physician-documented contraindication was present. Upon request, the facility was unable to provide any records of consent, declination, or physician-documented contraindication for these residents. Interviews with administrative staff confirmed that documentation for the vaccines given or signed declinations could not be found. Staff changes were cited as a possible reason for the missing information, and the facility was also unable to provide a policy related to the administration of the COVID-19 vaccination. This lack of documentation and policy resulted in a failure to ensure proper vaccination status tracking for the affected residents.

See complete original report
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