The California Department of Health has issued a new All Facilities Letter requiring skilled nursing facilities, intermediate care facilities, and nursing facilities to offer on-site H1N1 influenza vaccinations to residents aged 65 or older. This requirement is in addition to the existing mandate for seasonal influenza and pneumococcal vaccinations. Facilities must offer the H1N1 vaccine unless it is medically contraindicated, against the resident's personal beliefs, or against the resident's or their legal representative's wishes. Facilities are exempt from providing the vaccine if they cannot obtain it due to supply shortages or if the resident refuses to pay and there is no other funding source. The H1N1 vaccine must be administered in accordance with the Centers for Disease Control and Prevention's guidelines. Non-compliance may result in penalties for affected healthcare facilities.

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