F0883

D

Lack of Documentation and Administration of Influenza Vaccination After Consent

Monroe, Wisconsin Survey Completed on 03-24-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to ensure that a resident was offered and received an influenza vaccination, and that the resident’s medical record contained documentation of administration, refusal, or education regarding the vaccine. The facility had a written Influenza Vaccination policy dated 7/1/25 stating that individuals receiving the influenza vaccine, or their legal representative, must provide consent prior to administration and that the consent would be located in the resident’s medical record. For one resident (R4), the Activated Power of Attorney (APOA) signed the facility’s Influenza Vaccination Information and Release Form on 10/2/25, indicating that they had read information about influenza and the flu vaccine, understood the benefits and risks, and requested that the influenza vaccine be given to the resident named on the form.

Despite the signed consent, surveyor review of R4’s electronic health record revealed no documentation that the influenza vaccination was administered, nor any record of refusal or education. During an interview on 3/23/26, the DON stated that they had located the consent but were still looking for documentation that the vaccine had been given. On 3/24/26, the DON reported they were unable to find any documentation indicating that R4 had received the influenza vaccination. When asked if the expectation would be that the vaccine was administered when a signed consent was present, the DON confirmed that this was the expectation.