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F0883
D

Failure to Administer and Document Pneumococcal Vaccine

Costa Mesa, California Survey Completed on 08-29-2025

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 administer the pneumococcal vaccine to one of five sampled residents reviewed for immunizations. According to the facility's policy and procedure, all residents are to be assessed for eligibility and offered the pneumococcal vaccine series within thirty days of admission, unless medically contraindicated, previously vaccinated, or refused by the resident. Medical record review for the resident in question showed that the resident was approached and verbally consented to receive the influenza, pneumococcal, and COVID-19 vaccines. However, there was no documented evidence in the medical record that the pneumococcal vaccine was administered or refused. During interviews and concurrent medical record review, both the Infection Preventionist (IP) and Director of Nursing (DON) confirmed that the pneumococcal vaccine had not been given to the resident. The facility's policy also requires documentation of vaccine administration or refusal, as well as education provided to the resident or their representative. The absence of documentation and lack of vaccine administration constituted a failure to follow established procedures for immunization.

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