F600: free from abuse and neglect
Short answer
F600 protects every nursing home resident's right to be free from abuse and neglect. This covers harm by staff, another resident or a visitor. CMS says the facility can be cited if abuse occurred, even if it screened, trained and acted promptly. Reporting and investigation duties sit in F609 and F610.
- Tag title
- Free from Abuse and Neglect
- Regulation
- 42 CFR 483.12(a)(1)
- Guidance relied on
- Appendix PP Rev. 232 (issued 07-23-25, in use since 04-28-25). F600 section Rev. 211 (02-03-23)
- Reporting clocks
- In F609: 2 hours for abuse or serious bodily injury. 24 hours otherwise. Results within 5 working days
- Severity note
- Level 1 does not apply. Abuse can be cited at harm or immediate jeopardy with no documented injury
- How often cited
- 406 citations in CMS Region 5 (IL, IN, MI, MN, OH, WI) in the first half of 2026 (Wisconsin DHS summary)
- Related tags
- F602, F603, F607, F609, F610, F656, F689
Applies to: Medicare-certified skilled nursing facilities · Medicaid-certified nursing facilities
What F600 covers
F600 enforces 42 CFR 483.12(a)(1). The facility may not use verbal, mental, sexual or physical abuse. It may not use corporal punishment or involuntary seclusion. Misappropriation and exploitation go to F602, and involuntary seclusion to F603.
CMS defines abuse as willful infliction of injury, unreasonable confinement, intimidation or punishment. The result is harm, pain or mental anguish. Abuse also covers deprivation of needed goods or services. Abuse through technology counts too, such as demeaning photos shared on social media. Willful means the act was deliberate, not that harm was intended.
Neglect is a failure to provide the goods and services needed to avoid physical harm, pain, mental anguish or emotional distress. At F600, neglect is about structures and processes: the facility's systems for staffing, supplies, training and oversight. One missed task is usually cited at the care tag, such as F686 or F689.
Staff includes employees, the medical director, consultants, contractors, volunteers and students. The person responsible can also be another resident or a visitor. A resident-to-resident altercation is reviewed as potential abuse. Cognitive impairment does not rule out a deliberate act.
What surveyors check and ask for
Surveyors use the Abuse Critical Element Pathway (CMS-20059) or the Neglect pathway (CMS-20130). They establish what happened, what protected the resident, and what the facility did next.
| Type | Surveyors ask for | Have ready |
|---|---|---|
| Staff to resident | Shift roster and timecards. Abuse-prevention training logs. Personnel record of the person involved. | Screening, discipline and training dates. Who supervised the unit. |
| Resident to resident | Behavior history. Mood, behavior and cognition assessments. Care plan interventions. | Proof each intervention happened. Proof supervision was adequate. |
| Visitor to resident | Social history. Visitor access policy and any restriction. | Evidence the facility acted on earlier concerns. |
| Neglect | Policies. Staffing and supply records. How leadership monitors care. | How leadership responded to staff concerns. |
Surveyors also check that the care plan was revised after the event (F656). CMS says physical or sexual abuse by staff or residents always requires corrective action and tracking by the QAA committee.
What makes an F600 deficiency more severe
CMS tells surveyors to weigh psychosocial (emotional) harm with a reasonable-person test. The question: what would a person in this resident's position be expected to feel? Abuse can be cited at harm or immediate jeopardy (level 4, the top level) without a documented injury or visible reaction.
CMS lists these as likely immediate jeopardy: sexual assault and unwanted sexual touching. Any staff-to-resident physical, sexual, mental or verbal abuse is also listed. So are staff sharing demeaning photos or video and threats to withhold care as punishment. So is resident-to-resident physical abuse likely to cause fear or anxiety. A resident-to-resident incident that would likely harm a reasonable person is not cited below level 3.
| Level | Example from CMS guidance |
|---|---|
| 4: immediate jeopardy | A resident with known sexually inappropriate behavior was found with a severely cognitively impaired resident. There was no assessment or care plan revision. In another case, a resident who needed 1:1 supervision pushed a resident, who fractured an arm, while unsupervised. |
| 3: actual harm | A resident slapped another in the face after earlier aggressive remarks to others. The one nurse aide present was transferring a third resident. |
| 2: potential for more than minimal harm | A resident verbally abused another at a shared table. Staff did not intervene. No altercation was documented. |
Past noncompliance can also be cited. The facility may have corrected the problem before the survey. Then surveyors record its corrective actions on the CMS-2567, and no plan of correction is required.
Reporting clocks
F600 has no clock of its own. The clocks sit in F609 and F610. They run in real time, not business hours.
| Step | Deadline |
|---|---|
| Report abuse to the administrator and State Survey Agency. This includes any allegation that results in serious bodily injury. | Immediately. No later than 2 hours after the allegation is made. |
| Report neglect, exploitation, mistreatment or misappropriation. This is for cases with no abuse and no serious bodily injury. | No later than 24 hours |
| Report the investigation results. Include corrective action if the allegation is verified. | Within 5 working days of the incident |
Documentation gaps that lead to citations
- A confused resident's report goes unrecorded. CMS says not to dismiss allegations because of cognitive impairment.
- The record says altercation. It never says whether the act was deliberate.
- Interim protection is undocumented: who was separated, what supervision was added, who checked.
- Neither resident's care plan is revised after the event.
- No record shows abuse-prevention training before the event, or agency staff orientation.
- Incident reports sit in a folder. The QAA committee sees a monthly count.
Show a good investigation and corrective action
- Protect firstSeparate the people involved, assess the resident, and record what changed and who is watching.
- Report on the clockNotify the administrator and State Survey Agency. Record the clock time and any report to law enforcement.
- Investigate with evidenceInterview, observe, review records. Keep the proof together. See F610.
- Correct at the system levelIf verified, fix what allowed it: staffing, supervision, training, care plan, policy. Name an owner and a date.
- Track itTake it to the QAA committee. Check the fix held. Close only with proof.
How IncidentKit supports F600
IncidentKit is the record, not the decision-maker. Lauren asks who was involved and what protected the resident, then drafts the incident for a person to review and sign. Routing and escalation alerts the roles you set. The audit trail logs who did what and when.
How IncidentKit supports this requirement
| What the rule asks for | Where it lives in IncidentKit |
|---|---|
| Protect residents from abuse and neglect by anyone | QR quick report, text, email and web form let staff report on the spot. Routing and escalation alerts the roles you set. |
| Show what protected the resident after an allegation | The incident record holds interim protections and their owners. The audit trail logs every change. |
| Identify behavior that raises risk between residents | Analytics group incidents by location, shift and cause. |
| Revise care plans and correct systems after a verified event | Corrective actions carry an owner, due date, evidence and an effectiveness check. Nothing closes until verified. Care plan edits stay in your EHR. |
| QAA committee tracking of abuse cases | Compliance packets include a QAPI summary drawn from incidents and corrective actions. |
Product parts involved: Incident reporting, QR and quick report, Lauren, the AI assistant, Routing and escalation, Investigations and RCA, Corrective actions (CAPA), Audit trail, Compliance packets. Capabilities marked “rolling out” are being released in stages; see the changelog.
Frequently asked questions
Can a nursing home be cited at F600 even if it did everything right?
Yes. The resident has a right to be free from abuse. CMS rejects the argument that screening, training and prompt reporting mean abuse could not be foreseen. If surveyors find abuse occurred, they may cite current or past noncompliance.
Is every resident-to-resident altercation abuse?
No. Surveyors treat it as potential abuse, then ask whether the act was willful (deliberate). Normal social arguments are not abuse. A resident with dementia can still act deliberately. If the act was not willful, they review supervision and hazards at F689.
What counts as neglect at F600?
Neglect is a failure of the facility's systems, such as too few staff, missing supplies, no training or weak oversight. A single missed task usually goes to the care tag. Surveyors need evidence that leadership knew or should have known and did not act.
Are staff photos of residents covered by F600?
Yes. CMS counts abuse through technology, including keeping or sharing demeaning or humiliating photos and recordings, with or without the resident's consent. Staff sharing such images is likely immediate jeopardy.
Which tag covers reporting an abuse allegation late?
F609 covers late or missing reports. F610 covers weak investigations and lapses in protecting the resident during one. One event can draw citations at all three.
Sources
- eCFR, 42 CFR 483.12 (freedom from abuse, neglect, and exploitation), current through 2026-10-01
- CMS State Operations Manual, Appendix PP, Guidance to Surveyors for Long Term Care Facilities (Rev. 232, issued 07-23-25; revised guidance used on surveys since 04-28-25): F600 section (Rev. 211, issued 02-03-23, effective 10-21-22, implementation 10-24-22)
- CMS State Operations Manual, Chapter 7, Survey and Enforcement Process for Skilled Nursing Facilities and Nursing Facilities (Rev. 244, issued 06-26-26): scope and severity matrix, immediate jeopardy, substandard quality of care
- eCFR, 42 CFR 488.301 (definitions: immediate jeopardy, substandard quality of care), current through 2026-10-01
- CMS memo QSO-25-14-NH (revised 2025-03-10): Revised Long-Term Care Surveyor Guidance, effective April 28, 2025
- Wisconsin Department of Health Services, Top Ten Federal Health Citations, First Half 2026 (national, state and CMS Region 5 citation counts)
Reviewed against the sources above on Oct 5, 2026. Rules change: confirm current requirements with the issuing body or your counsel before relying on any summary.
Map this requirement to your records.
IncidentKit connects each rule to the incident, investigation and corrective action that satisfy it.