HospitalInspections.org

Based on review of QSO memo 22-09-ALL Attachment D, review of facility COVID-19 vaccination records, and staff interview, the facility failed to ensure all staff were fully vaccinated against COVID-19 at 100 percent compliance after the 90 days of issuance of the memorandum. The facility had a total of 15,977 staff that were vaccinated/exempt for a total vaccination rate of 98.5%. The facility census was 1021.

Findings include:

Review of QSO memo 22-09-ALL Attachment D, dated 01/14/22, revealed after 90 days the expected minimum vaccination threshold should be 100 percent.

Review of the employee vaccination list received on 06/07/22 revealed the facility had a total of 15,733 of 15,977 staff that were vaccinated for COVID-19. The total vaccination rate was 98.5 percent.

Interview with Staff A on 06/07/22 at 9:00 AM confirmed the above findings.

Review of the policy titled "Non-Discretionary Vaccine", effective 05/09/22, revealed the facility will provide and require vaccines for all new and current medical staff and employees. Immunizations will be necessary to obtain and/or retain employment within the organization and must be received no later than the deadline established.