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F0883
D

Failure to Administer Vaccinations Despite Consent

Frederic, Wisconsin Survey Completed on 07-01-2025

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

A deficiency occurred when a resident with severe cognitive impairment, as indicated by a BIMS score of 6/15 and diagnoses of cerebral infarction and vascular dementia, was not administered influenza, COVID-19, or RSV vaccinations despite having signed consents on file. The facility's policies required annual offering and documentation of these immunizations unless contraindicated or refused, but there were no physician orders or treatment administration records for these vaccines for the resident during their stay. Surveyor review of the Wisconsin Immunization Record confirmed that no immunizations were administered to the resident while at the facility. Additionally, there were inconsistencies in the vaccination consent forms, with two different consents signed by the resident's parent and a handwritten note referencing verbal consent. The DON was unable to explain the discrepancies in the consents or provide documentation or explanation for the lack of vaccine administration.

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