Health inspection·June 22, 2023

F 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview and review of a facility policy, the facility failed to ensure residents were offered pneumococcal vaccines. This affected two residents (#02 and #18) out of the five residents reviewed for immunizations. The facility census was 43. Residents Affected - Few Findings include: 1. Review of the Resident #02's chart revealed the resident was admitted to the facility on [DATE] with diagnoses including, but not limited to, cerebral palsy, muscle weakness, hyperlipidemia, hypertension, chronic obstructive pulmonary disease (COPD) and anemia. Review of Resident #02's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident to be moderately cognitively impaired. Review of immunization history for Resident #02, revealed the resident received a Pneumovax 23 vaccine on 12/27/07. Resident #02 had no education on pneumococcal vaccines, no consents on file, and there was no documented evidence Resident #02 was offered or received an updated pneumococcal vaccine since 12/27/07. Interview on 06/21/23 at 9:36 A.M. with Registered Nurse (RN) #27 verified Resident #02 received a Pneumovax 23 vaccine on 12/27/07 and Resident #02 did not have any updated consents offering Resident #02 an updated pneumococcal vaccine. 2. Review of the Resident #18's chart revealed Resident #18 admitted to the facility on [DATE] with diagnoses including, but not limited to, unspecified dementia, pain in the right hand, muscle weakness, anxiety disorder, anemia, hypothyroidism, other symbolic dysfunctions, and mixed hyperlipidemia. Review of Resident #18's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident to be severely cognitively impaired. Review of the immunization history for Resident #18, revealed the resident received a Pneumovax 23 vaccine on 01/01/16. Resident #18 had no education on pneumococcal vaccines, no consents on file and there was no documented evidence Resident #18 was offered or received an updated pneumococcal vaccine since 01/01/16. Interview on 06/21/23 at 9:36 A.M. with RN #27 verified Resident #18 last received a pneumococcal vaccine on 01/01/16 and Resident #18 did not have any updated consents offering Resident #18 an Page 1 of 3 365538 365538 06/22/2023 Friends Extended Care Center 150 East Herman Street Yellow Springs, OH 45387

F 0883 updated pneumococcal vaccine. Level of Harm - Minimal harm or potential for actual harm Review of the facility's pneumococcal vaccine policy dated 10/26/15 revealed all residents will be offered pneumococcal vaccines to aid in preventing pneumococcal infections. Residents Affected - Few 365538 Page 2 of 3 365538 06/22/2023 Friends Extended Care Center 150 East Herman Street Yellow Springs, OH 45387

F 0887 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure a resident was offered a Coronavirus (COVID-19) vaccine. This affected one resident (#17) out of five residents reviewed for immunizations. The facility census was 43. Findings include: Review of the Resident #17's chart revealed the resident was admitted to the facility on [DATE] with diagnoses including cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery, hyperlipidemia, type two diabetes mellitus, malignant neoplasm of prostate, major depressive disorder, and abnormal posture. Review of Resident #17's admission Minimum Data Set (MDS) assessment dated [DATE] revealed the resident to be severely cognitively impaired. Review of Resident #17's COVID-19 vaccine consents revealed Resident #17 did not have a COVID-19 vaccine consent on file declining or accepting the vaccine. Review of Resident #17's COVID-19 vaccine history revealed Resident #17 did not have a history of receiving a COVID-19 vaccine. Interview on 06/21/23 at 9:36 A.M. with Registered Nurse (RN) #27 verified Resident #17 did not have a consent declining or accepting the COVID-19 vaccine and Resident #17 did not have any documentation that he received a COVID-19 vaccine prior to admission to the facility. Review of the facility's undated offering residents COVID-19 immunizations policy revealed the facility will notify all residents that the vaccination is available to them. 365538 Page 3 of 3