cms_GA: 2682
Data source: Big Local News · About: big-local-datasette
rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
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2682 | PINEWOOD MANOR NURSING HOME & REHABILITATION CNTR | 115586 | 277 COMMERCE STREET | HAWKINSVILLE | GA | 31036 | 2017-09-21 | 334 | E | 0 | 1 | V4Q111 | Based on clinical record review and staff interview the facility failed to provide education for the potential side effects of the influenza (flu) vaccine for the (YEAR)/2017 flu season and failed to have documentation in each resident's medical record to indicate consent or decline of the flu vaccine for the (YEAR)/2017 flu season for five of the five residents (R#17, R#20, R#45, R#52 and R#67) reviewed for immunization compliance. The sample size was 31 residents. The findings include: 1. On 9/21/17 at 9:15 a.m., interview with the Director of Nursing (DON) revealed she was responsible for monitoring infection control which included information regarding flu immunization/vaccine data. She further revealed education had been provided to the resident's and their families by the former DON, however, she was unable to locate a copy of the education which had been provided to each resident and/or their representative regarding the benefits and potential side effects for the flu vaccine. She confirmed there was no documentation in the medical record for R#17, R#20, R#45, R#52 and R#67 to indicated education on the benefits and potential side effects of the flu vaccine had been provided to them. On 9/21/18, review of the clinical medical record for R#17, R#20, R#45, R#52 and R#67 revealed there was no documentation present to indicate education on the benefits and potential side effects of the flu vaccine for the (YEAR)/2017 flu season had been provided to them. 2. On 9/21/17 at 9:15 a.m. during the interview with the DON, an undated facility document Vaccine Roster Influenza Vaccine (YEAR)-2017 was reviewed. The documentation revealed a roster for residents who received or refused the flu vaccine during the (YEAR)-2017 flu season. The roster had columns for Room, Resident, Date Given, Temp, Site, Signature. The DON stated this was documentation of consent the facility uses. The facility staff had the resident sign this form as consent. They did not have a form which the resident or their representative could sign for consent or declination to place in each resident's clinical medical record. She further stated this was the only place consent or refusal was noted and the roster was not placed in an individual medical record because each page contains multiple resident information. On 9/21/17, review of the clinical medical record for R#17, R#20, R#45, R#52 and R#67 revealed there was no documentation in any of the records to indicate the resident was given the opportunity to consent or decline the flu vaccination. The DON confirmed the medical record for R#17, #20, R#45, R#52, and R#67 contained no documentation for consent or decline of the flu vaccine for the (YEAR)/2017 flu season. Review of facility policy titled Influenza Vaccination implemented 1/4/2014 and revised on 4/25/2017 by the Administrator and the DON revealed in the section titled .Policy Explanation and Compliance Guidelines, #4 .Prior to the administration of the influenza vaccine, the person receiving the immunization, or his/her legal representative, will be provided with a copy of CDC's (Center for Disease Control) current vaccine information statement relative to the influenza vaccination. #6 .Individuals receiving the influenza vaccine, or their legal representative, can give oral or written permission. #8 .The resident's medical record will include documentation that the resident and/or the resident's representative was provided education regarding the benefits and potential side effects of immunization, and that the resident received or did not receive the immunization due to medical contraindication or refusal. The facility failed to follow their policy regarding documentation of education and consent/declination of the flu vaccination for the (YEAR)/2017 flu season. | 2020-09-01 |