# Immediate jeopardy > Immediate jeopardy (IJ) means a provider's failure has caused, or will likely cause, serious harm or death. It is the most serious kind of deficiency. Source: https://incidentkit.ai/glossary/immediate-jeopardy ยท Updated Oct 5, 2026 Also known as: IJ, immediate jeopardy to resident health or safety ## The three parts CMS Appendix Q says the wording varies a little by provider type but has three parts. All three must be present. 1. Noncompliance with one or more federal health, safety or quality rules. 2. A serious bad outcome, or a likely one, for one or more people at risk. 3. A need for immediate action to stop serious harm from happening or happening again. Serious outcomes include death, a major drop in function not due only to disease or age, loss of a limb or disfigurement, and avoidable pain that is excruciating and lasts more than a short time. ## After IJ is called The survey team confirms the finding with the State Agency, tells the administrator right away, and asks for a written removal plan. Removal is checked on site. In nursing homes, IJ is scored J, K or L. CMS applies penalties without first letting the facility fix it. Mix-up: a removal plan is not a [plan of correction](https://incidentkit.ai/glossary/plan-of-correction). The removal plan stops serious harm now and need not fix everything. The plan of correction comes next and shows how the facility gets back to substantial compliance. Example: a resident known to be at risk of leaving is not supervised as the care plan says, and walks out in cold weather. CMS lists heat or cold exposure as a risk of [elopement](https://incidentkit.ai/glossary/elopement). ## Frequently asked questions ### What is an IJ removal plan? Steps taken right away so no one suffers serious harm. It names affected residents and the system change, with the date harm is no longer likely. ### How is immediate jeopardy different from actual harm? Actual harm (level 3, G to I) means a resident was harmed, but not to the IJ standard. IJ (level 4, J to L) means serious injury, harm, impairment or death has happened or is likely. ### Does immediate jeopardy apply to hospitals and surgery centers? Yes. Appendix Q is core guidance for certified providers, suppliers and labs. Other providers use the 42 CFR 489.3 definition. CMS may require a shorter time to fix an IJ. ## Sources - [CMS State Operations Manual, Appendix Q: Core Guidelines for Determining Immediate Jeopardy](https://www.cms.gov/Regulations-and-guidance/Guidance/Manuals/downloads/som107ap_q_immedjeopardy.pdf) - [42 CFR 488.301: Definitions (nursing home survey and enforcement)](https://www.ecfr.gov/current/title-42/section-488.301) - [CMS State Operations Manual, Chapter 7: Survey and Enforcement Process for Skilled Nursing Facilities and Nursing Facilities](https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107c07pdf.pdf) - [42 CFR 488.28: Providers or suppliers, other than SNFs, NFs, HHAs and hospices, with deficiencies](https://www.ecfr.gov/current/title-42/section-488.28) - [CMS State Operations Manual, Appendix PP: Guidance to Surveyors for Long Term Care Facilities](https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf) ## Related terms - [Deficiency](https://incidentkit.ai/glossary/deficiency) - [Plan of correction](https://incidentkit.ai/glossary/plan-of-correction) - [CMS-2567](https://incidentkit.ai/glossary/cms-2567) - [Elopement](https://incidentkit.ai/glossary/elopement) - [Harm scale](https://incidentkit.ai/glossary/harm-scale) ## Related - [Nursing home recertification survey: process and prep](https://incidentkit.ai/compliance/survey-readiness/snf-recertification-survey) - [Plan of correction (CMS-2567): elements and 10-day deadline](https://incidentkit.ai/compliance/survey-readiness/plan-of-correction) - [F689 accidents and supervision: falls, hazards, devices](https://incidentkit.ai/compliance/f-tags/f689) - [F600 free from abuse and neglect: what surveyors cite](https://incidentkit.ai/compliance/f-tags/f600) - [What to put in a plan of correction (CMS-2567)](https://incidentkit.ai/blog/what-to-put-in-a-plan-of-correction)