In this edition of The State of IJs, we’re spotlighting Immediate Jeopardy (IJ) citations issued to nursing homes across South Carolina. These citations represent the most serious level of noncompliance, where resident safety is at immediate risk. Understanding the patterns behind these citations can help providers proactively address vulnerabilities and improve care outcomes.
Top Areas of Noncompliance
The most frequently cited IJ deficiencies in 2025 in South Carolina include:
- F578 Request/Refuse/Discontinue Treatment; Formulate Adv Di
- F689 Free of Accident Hazards/Supervision/Devices
Tied for the #3 spot are F600 Free from Abuse and Neglect and F880 Infection Prevention and Control.
Compliance Insights
We’ve discussed a lot about advance directives, accidents and abuse/neglect in the past month that we’ve been reviewing IJs from around the US. However, we haven’t seen a lot of F800 IJs so we can’t ignore these three situations that were cited at as widespread (S/S: L) deficient practices.
Glucometers
Shared equipment (such as glucometers) tends to be an infection control issue that is frequently cited – and depending on the state, it can be at a high scope and severity.
A facility put a process in place to ensure each resident had his/her own glucometer but there were still multiple issues identified. During a medication pass observation, an RN told the surveyor that each resident had his/her own glucometer and went to get the glucometer from the pouch for the next resident, which was of course, empty. She looked through the med cart and found an unlabeled glucometer and stated that she had used that one for the resident’s fingerstick prior to lunch. She then proceeded to wipe the glucometer with an alcohol pad and go to the same resident’s room to check her blood sugar. She used the unlabeled glucometer, then she returned to the cart, used an alcohol wipe to clean it and put the unlabeled glucometer into the resident’s pouch.
See where this is going? The surveyor then asked several other licensed staff the process for cleansing the glucometers – with several different answers – with only one staff stating that she used the appropriate wipe to cleanse the glucometer. The surveyor then observed another licensed staff member using an alcohol wipe on a glucometer and returning it to the resident’s pouch. On interview, the Director of Nursing explained the facility’s procedure, which included an alcohol pad and then a germicidal wipe – with 3 minutes of contact time required after using the germicidal wipe. This was obviously not observed, and staff were not even able to verbalize the facility’s process.
Laundry
There are two IJ citations in South Carolina related to laundry services and infection control.
A facility landed in an IJ situation when it was observed by a surveyor that the washing machine containing linens and gowns was running, but no detergent was coming through the lines of the washer. Temperature gauges for this washer and the second washer, which was out of service, were not observed. Staff assigned to the laundry room stated that they had no way of taking the temperature and had not been taught how to do so.
Another facility was cited for multiple issues related to laundry, including:
- It was identified that there was a lack of separation between the clean and soiled laundry room.
- Laundry staff did not adhere to manufacturer’s guidelines regarding the use of detergents and sanitizers.
- Heavily soiled items were being rinsed out in areas such as the sinks in shared shower rooms or resident bathrooms.
Here’s what providers need to consider to avoid citations in this area.
These issues all stem from a lack of sufficient education, training and competency of staff performing assigned duties. All of these facilities had policies and procedures in place which were not being followed, and staff could not correctly verbalize or were not familiar with.
This presents two areas to think about:
- Are your staff who are responsible for training others or conducting competencies of other staff members actually competent themselves? Does that person know the facility’s policy inside and out to ensure that staff are following it? Who is responsible for monitoring and observing your staff to ensure they are following protocol?
- Are your staff’s responsibilities clearly spelled out and is someone monitoring that duties are being carried out correctly? We’ve mentioned this in a couple of our posts about Immediate Jeopardy citations in 2025 but will mention it again now: ensure someone is responsible for monitoring logs, that maintenance or the appropriate vendor is contacted when there are issues and that staff are aware of their responsibility to report issues – and to whom – for timely follow-up.
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