In this edition of The State of IJs, we’re spotlighting Immediate Jeopardy (IJ) citations issued to nursing homes in Kansas. IJ citations represent the most serious level of noncompliance, where resident safety is at immediate risk. Understanding the pattern of findings associated with any citation, which is usually spelled out in the Statement of Deficiencies, can help providers proactively address vulnerabilities and improve care outcomes within their own facility.
Top Areas of Noncompliance
The most frequently cited IJ deficiencies in 2025 in Kansas include, not surprisingly:
- F689 – Free of Accident Hazards/ Supervision/Devices
- F600 – Free from Abuse and Neglect
However, we are going in another direction today to explore a F675 Quality of Life citation cited at a scope and severity of J (Isolated). Guidance in the SOM directs that this tag should not automatically be cited when noncompliance has been identified in Resident’s Rights/Quality of Care/Abuse-Neglect or other regulatory tags, unless the cumulative effect of the noncompliance creates an environment that reflects a complete disregard of one or more residents’ well-being, and rises to the level of Immediate Jeopardy, which the State Agency determined had occurred in this case.
What happened, in this instance, is that a facility’s nursing staff failed to identify changes in a resident’s bowel pattern that indicated a fecal impaction and implement necessary changes to the plan of care. The outcome of this failure led to a resident being transferred to the hospital and subsequently required anesthesia to have a “large stool ball” removed from his upper rectum after appropriate physical exams and diagnostic testing were completed.
Compliance Insights
Issues that should have been addressed when identified and/or reported:
- A resident’s breath smelling of feces
- Lack of bowel movements
- Staff not knowing that a smear of feces on an incontinence brief is not a small bowel movement – per the Statement of Deficiencies the prior DNS had instructed staff that a smear was to be recorded as a small bowel movement
- Omission in bowel movement documentation
- Staff not implementing ordered care interventions, including those prn orders, available to them when a resident has not had a bowel movement for a specific period of time
What else was there:
- Obvious poor communication between CNAs, CMAs and licensed nurses
- Not maintaining a system that held licensed nurses responsible for monitoring completion of documentation and implementing appropriate interventions for identified bowel concerns
- The need for nursing staff education related to recognizing the signs and symptoms of constipation and fecal impaction
There is not a nursing home out there that doesn’t fear a resident being diagnosed with a fecal impaction as we all understand the potential repercussions of this diagnosis on review internally or by an external entity. So, it might be worthwhile to pull out your Bowel Management protocol, review when education was last provided on this topic and do some random audits of your clinical records to see how good your compliance level is.
Build a Culture of Compliance That Lasts
CMS Compliance Group supports nursing homes with ongoing QA reviews, interdisciplinary coaching, and documentation strategies that hold up under scrutiny.
Schedule a strategy session at 631.692.4422 or cmscompliancegroup.com.
