F0887

F

Failure to Document and Track Staff COVID-19 Vaccination, Education, and Refusals

Kewanee, Illinois Survey Completed on 01-06-2026

Penalty

18 days payment denial

Summary

Surveyors identified a deficiency in the facility’s management of COVID-19 vaccination processes for employees. The facility’s own Interim COVID-19 Vaccination Guidelines for Residents and Employees, dated 12/2025, require that staff be provided education on the risks, benefits, and potential side effects of the COVID-19 vaccine, be offered the vaccine or information on obtaining it, and that the facility maintain documentation of staff education, vaccination status, and refusals, including information needed for NHSN reporting. The CMS Form 671 dated 1/5/26 and signed by the Administrator documents that 53 residents reside in the facility.

During interviews, the Infection Preventionist stated there was no log of employees who had received the COVID-19 vaccine and no record of employees who refused it. The Administrator confirmed that the facility did not keep COVID-19 vaccination logs for employees, did not have employees sign a refusal form, and did not track education provided to new employees who refused the COVID-19 vaccination. As a result, the facility failed to document and track employee COVID-19 education, vaccine administrations, and vaccine refusals as required by its policy.