Based on interview, record review, and policy review, it was determined that the facility failed to implement their pneumococcal vaccine policy for 2 of 5 residents reviewed for immunizations. (Resident identifiers are #97 and #120.)Findings include:Review on 7/1/25 of the facility policy titled, Pneumococcal Vaccine, review date of 6/2025, revealed the following: .1. Each resident will be assessed for pneumococcal immunizations upon admission. Self-reported immunizations shall be accepted. Any additional efforts to obtain information shall be documented, including efforts to determine date of immunizations or type of vaccine received. 2. Each resident will be offered a pneumococcal immunizations unless it is medically contraindicated or resident has already been immunized. …
F883 citations in New Hampshire
Flu and pneumonia vaccines · Infection Control Deficiencies
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
New Hampshire cites F883 more often than its own record predicts
1.13 times the share F883 takes of citations nationally.
Of every deficiency written in New Hampshire in 2025, this is the portion that was F883.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What New Hampshire surveyors wrote
F883 findings written in New Hampshire, one from each severity band recorded here, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
Based on review of the individual facility unit pneumococcal resident Report Sheets and interview the facility failed to ensure and implement a facility system for the monitoring and recording of pneumococcal immunizations. Findings include: Review on 3/5/19 at approximately 10:00 a.m. of the facility pneumococcal monitoring and tracking documentation with Staff C (Director of Nursing) revealed that the West unit documents a Y in the section indicating that the resident has received the pneumococcal vaccine and does not document the date the pneumococcal vaccine was given, the East unit utilizes the same form and indicates Y with the date the resident was given the pneumococcal vaccine and the Rehabilitation unit utilizes the facility INFORMED CONSENT FOR PNEUM[NAME][NAME]CAL VACCINE and… …
The short window
Recent years
| Year | Share of New Hampshire citations | vs expected |
|---|---|---|
| 2023 | 2.05% | 2.32× |
| 2024 | 1.50% | 1.98× |
| 2025 | 0.72% | 1.13× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else New Hampshire surveyors cite →
Deficiency Index is independent and is not affiliated with, endorsed by, or approved by CMS, Medicare, or any government agency. About this data · Report a correction