Complaint Investigation Report

Allegation: " Staff failed to follow authorized representative's directive to reject flu shot administration." Based on document review and interviews conducted the findings indicate that on 10/5/201 former resident (R1) was administered a flu shot at the facility by CVS pharmacy. It is alleged that authorized representative communicated to facility staff in advance that R1 has never received a flu shot; therefore chose to reject the flu shot, but agreed to receiving the COVID-19 booster shot. Resident (R1) has limited English language proficiency, and attempted to communicate to staff that it was rejecting the flu shot. According to interviews, staff informed R1 that the vaccine the resident was going to receive was the COVID-19 booster shot. Prior to the COVID-19 booster shot administration it was discovered R1 was still not eligible for the booster shot since it had not been at least 6 months from the 2nd COVID-19 vaccine dose.

Resident (R1) signed the flu shot consent thinking the consent was for the COVID-19 booster shot. Resident (R1) does not have a Power of Attorney. Therefore, the facility did not contact the authorized representative regarding vaccine consent. It is alleged that resident (R1) has cognitive impairment due to past health history and current health diagnosis. However, the Physician's Report does not indicate any Mild Cognitive Impairment or Dementia. A total of nine (9) residents were interviewed and all stated the flu shot was administered with their consent. Staff stated that residents and/or their authorized representative signed in advance the vaccine consent forms. Staff stated that on the date the flu shots were administered R1 willingly accepted the flu shot vaccine, after it was notified that there were extra flu shots available. A copy of the flu shot consent form signed by resident (R1) was obtained.

Based on interviews conducted and record reviewed there is insufficient information to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated.

Exit interview conducted with Executive Director Barbara Tyler. A copy of the report was provided.