Based on interviews and record review, during the Recertification Survey initiated on 8/24/2022 and completed on 8/30/2022, the facility failed to develop and implement policies and procedures to ensure a contingency plan for staff who are not fully vaccinated to mitigate the transmission and spread of COVID-19. This was identified for one [Licensed Practical Nurse (LPN) #1] of one unvaccinated, medically exempted, staff reviewed for COVID-19 vaccination. Specifically, the facility policy and procedure did not include a contingency plan for staff who are not fully vaccinated. Additionally, LPN #1's medical exemption form did not specify which authorized or licensed COVID-19 vaccine is clinically contraindicated for the staff member. The finding is: The Centers for Medicare and Medicaid Services (CMS) QSO 22-07-ALL Attachment A for Long Term Care and Skilled Nursing Facility dated 12/28/2021, and last updated 4/05/2022, requires facilities to ensure those staff who are not yet fully vaccinated, or who have a pending or been granted an exemption, or who have a temporary delay as recommended by the CDC, adhere to additional precautions that are intended to mitigate the spread of COVID-19. Accommodations of Unvaccinated Staff with a qualifying exception could include mandatory routine COVID-19 testing in accordance with Occupational Safety and Health Administration (OSHA) and CDC guidelines, physical distancing from co-workers and patients, re-assignment or modifications of duties, teleworking, or a combination of these actions. Accommodations can be addressed in the facility's policies and procedures. The facility's Policy and Procedure titled, COVID Vaccination Policy dated 8/26/2021, documented employees were required to be up to date with the COVID-19 vaccination as of September 27, 2021. The Policy and Procedure did not document additional precautions for those personnel with approved medical exemptions to prevent the spread of COVID -19 infection. A review of the COVID-19 staff vaccination matrix received on 8/29/2022 indicated there was one staff member, LPN #1, with a medical exemption for the COVID-19 vaccine. Review of the Request for Exemption from COVID-19 Vaccination Mandate Based on Medical Reasons form dated 9/8/2022 did not include which authorized or licensed COVID-19 vaccine is clinically contraindicated for LPN #1. LPN #1 was interviewed on 8/30/2022 at 10:21 AM and stated they (LPN#1) were medically exempt from the COVID-19 vaccination and were using a surgical mask when on the nursing units and providing resident care. LPN #1 stated they (LPN #1) are currently wearing an N95 mask because of the COVID -19 outbreak of two COVID-19 positive residents in the facility. The Director of Nursing Services (DNS), who is also the Infection Control Preventionist, was interviewed on 8/30/2022 at 11:45 AM. The DNS stated that the facility currently had two COVID-19 positive residents in the facility as of 8/26/2022. The DNS stated all staff are required to wear a surgical mask when in the facility unless the community rate increases. When the community rate for COVID-19 increases then all staff are required to wear an N95 mask covered by a surgical mask and must wear goggles. The Medical exempt staff are required to wear a surgical mask and eyeglasses (if needed) and are swabbed twice a week for COVID-19 infection. The DNS stated they were not aware that the facility policy should include contingency plans for staff who are not vaccinated. 10 NYCRR 415.19(a)(1-3)