Based on record review and staff interview, it was determined that the facility failed to develop and implement policies and procedures to ensure that 100% of staff were fully vaccinated, had an approved exemption, or had a temporary delay to receive the vaccination and/or was not eligible for the required second dose of COVID 19. This was evidenced by a 97.6% vaccination rate with 3 (#34, #35, and #22) of 85 direct hire staff and 1 (#36) of 4 contracted staff. The findings include: On 5/9/23 at 4:30 PM, a review of the facility's Policy, [Corporation Name] Mandatory Vaccination Policy revealed the facility failed to provide a date it was created. …
F888 citations in Maryland
Infection Control Deficiencies
Ensure staff are vaccinated for COVID-19
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2023
Maryland cites F888 more often than its own record predicts
1.70 times the share F888 takes of citations nationally.
Of every deficiency written in Maryland in 2023, this is the portion that was F888.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Maryland surveyors wrote
F888 findings written in Maryland, 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 interviews with facility staff, and a review of the facility's policies and procedures, it was determined that the facility failed to implement their policies and procedures for contingency plans for staff who are not fully vaccinated for COVID-19. This deficient practice has the potential to affect all residents, staff, and visitors in the facility. The finding includes: During an interview with the Infection Control Preventionist (ICP) on 12/05/22 at 10:20 AM, she stated the facility had two staff with religious exemptions COVID-19 vaccine. The ICP explained that two Nonvaccinated staff had the same assignment as vaccinated staff and were encouraged to have N-95 masks regardless of COVID-19 outbreak status. …
What else Maryland surveyors cite →
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