Understanding Immediate Jeopardy Citations is crucial for ensuring the quality and safety of nursing facility environments. In Fiscal Year 2023, several citations took the spotlight, shedding light on areas demanding careful attention in the year ahead. Let’s review the top five Immediate Jeopardy Citations and explore strategies for maintaining ongoing compliance.

Immediate Jeopardy Citations signify situations where a nursing facility’s non-compliance poses substantial risk to residents’ health and safety. Understanding causative factors behind these citations plays a pivotal role in driving continuous improvement in nursing facility care.

Top Immediate Jeopardy (IJ) Citations for FY2023

Top Five IJ Citations# IJ Citations% Providers Cited% Surveys Cited

1. F689 – Free of Accident Hazards/Supervision/Devices


F689 citations arise when facilities fail to provide adequate supervision, resulting in accident hazards for residents. This underscores the importance of robust safety measures and vigilant supervision to prevent incidents that could harm residents. The most common situations resulting in F689 IJ citations include elopements, accidents involving mechanical lifts, transportation accidents, and incidents involving smoking or choking.
2. F600 – Free from Abuse and Neglect


F600 was the second most frequently cited Immediate Jeopardy area in FY2023, which emphasizes the critical need for nursing facilities to create an environment free from abuse and neglect. Ensuring staff awareness, proper training, and implementing stringent anti-abuse policies are vital steps in avoiding this citation.
3. F684 – Quality of Care


Quality of care is at the heart of nursing facility services. Immediate Jeopardy in this category highlights deficiencies that directly impact residents’ health and well-being. Maintaining high-quality care involves continuous evaluation, staff training, and adherence to best practices.
4. F835 – Administration


Administrative lapses can lead to Immediate Jeopardy situations. Facilities must ensure efficient administration, including proper documentation, adherence to regulations, and effective communication channels within the organization.
5. F880 – Infection Control


Infection control is a critical area for nursing facilities. Immediate Jeopardy arises when facilities fail to implement robust infection control measures, putting residents at risk. Strict adherence to infection prevention protocols is paramount.


How Nursing Facilities Can Mitigate Immediate Jeopardy Risks

Identifying, remediating, and preventing Immediate Jeopardy situations is an essential area of compliance for nursing facilities. Early detection, swift correction, and proactive measures are essential components of effective risk management. Comprehensive staff training, regular audits, and collaboration with regulatory bodies are integral to mitigating Immediate Jeopardy risks. Proactive measures ensure ongoing compliance and contribute to a safer environment for residents.

Stay tuned in to IJ risks by registering for Proactive’s new 2024 webinar series, Deconstructing Immediate Jeopardy & High-Risk Tags. This series is designed to empower nursing facility professionals with the knowledge and strategies needed to navigate the top risk areas associated with Immediate Jeopardy citations. Real-life examples will provide insights into recent incidents. Drawing from real-life examples of IJ citations, we’ll delve into actionable solutions to prevent these critical citations in facilities.  Learn more and register


Shelly Maffia, RN, MSN, MBA, LNHA, QCP, CHC, CLNC, CPC
Director of Regulatory Services

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