F0883

D

Failure to Document Influenza and Pneumococcal Vaccination Status for a Resident

Burlington, Vermont Survey Completed on 03-25-2026

Penalty

No penalty information released

Summary

Surveyors identified a deficiency in the facility’s documentation of influenza and pneumococcal vaccinations for one resident. Record review on 03/25/2026 showed that Resident #124 was admitted on an unspecified date, and the EMR contained no documentation that the resident or their representative had been educated about, offered, and had either received or declined influenza and pneumococcal vaccines. An Immunizations Report from the EMR listed the resident’s influenza status as historical but did not include supporting documentation of the immunization, nor did it indicate whether the resident had received a pneumococcal vaccination. During interviews on 03/25/2026, the Infection Preventionist was unable to provide a Vaccination Review: Consent/Declination SNF Resident Form for this resident and confirmed that documentation of offering, educating, and either receiving or declining the influenza and pneumococcal vaccinations was not available. This lack of documentation was inconsistent with the facility’s written policies, which require education, completion of consent/declination forms, and placement of immunization documentation or reasons for non-immunization in the resident’s record.