**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and review of facility protocols and Centers for Disease Control and Prevention (CDC) immunization recommendations, the facility failed to ensure residents were offered pneumococcal immunizations based on CDC recommendations for 1 of 5 sample residents (#21) reviewed for immunizations. The findings were: 1. Review of the medical record showed resident #21 was admitted on [DATE] and was [AGE] years old. Further review of the medical record showed no evidence the resident had received pneumococcal vaccinations nor been offered pneumococcal vaccination since admission. During an interview on 7/10/24 at 3:28 PM the infection preventionist (IP) stated the resident had the pneumococcal conjugate vaccine (PCV13) in 2018. She stated the facility followed CDC recommendations and confirmed the resident should have been offered pneumococcal vaccination. She stated we missed that. On 7/10/24 at 5:10 PM the IP stated the resident's family was in the facility and had consented to the pneumococcal vaccination. 2. Review of the facility's protocol titled Immunizations-Pneumococcal and Influenza (Adult Inpatient), effective 6/2024, showed residents with prior pneumococcal vaccination of only PCV13 (at any age) should have PCV20 administered 1 year or later after the previous vaccination. 3. Review of Adult Immunization Schedule by Age by CDC located at https://www.cdc.gov/vaccines/schedules/hcp/adult.html (accessed 7/16/24) showed individuals 65 years or older who previously received only PCV13 should receive one dose of PCV20 or one dose of PPSV23.