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Survey teams must complete a preliminary IJ template with the specific noncompliance, seriousness threshold, and need for immediate action. Facilities then develop an IJ removal plan instead of a Plan of Correction, including root cause analysis, fishbone and five whys, necessary policy and procedure changes, staff training with objectives and post-tests, and scheduled supervision and performance evaluations. The plan also defines monitoring frequency to demonstrate elimination of imminent harm and sustained compliance, plus reporting requirements before the first revisit.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/immediate-jeopardy-ij-removal-plan-template-instructions/163152/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/immediate-jeopardy-ij-removal-plan-template-instructions/163152.png","ImageObject",442,249,{"name":88,"@type":89},"Terk","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/vnd.openxmlformats-officedocument.wordprocessingml.document","2026-10-02","2026-08-31",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",6,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What must surveyors do if they agree that Immediate Jeopardy exists?","Question",{"text":109,"@type":110},"Surveyors must immediately notify the facility by providing a completed IJ template and complete a preliminary IJ template identifying the specific noncompliance, the seriousness threshold, and the need for immediate action.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How is an IJ removal plan different from a Plan of Correction?",{"text":114,"@type":110},"An IJ removal plan must be developed instead of a Plan of Correction, while still containing the same core components.",{"name":116,"@type":107,"acceptedAnswer":117},"What activities should be included in the IJ removal plan to address root causes?",{"text":118,"@type":110},"The plan should initiate root cause analysis by interviewing involved direct care staff and immediate supervisors and completing a fishbone diagram and Five Whys.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},163152,1788138812,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":76,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":126,"read_time":9},1099525198933,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Immediate Jeopardy (IJ) and Removal Plan Instructions\nSurveyor Responsibilities:\nIf the survey team agrees that IJ exists, they will immediately notify the facility of the IJ by providing a completed IJ template. The survey team MUST complete a preliminary IJ template that includes identification of the specific noncompliance, threshold of seriousness and need for immediate action.\nFindings recorded on the IJ template are always preliminary. This includes any findings related to the IJ or to the completed IJ template that a survey team presents to the facility in the survey’s Exit Conference, regardless of whether the suspected IJ has been removed.\nFacility Steps:\nAn Immediate Jeopardy removal plan must be developed instead of a Plan of Correction; however, it contains the same components as a Plan of Correction.\nInitiate a Root Cause Analysis:\nInterviewing involved direct care staff and their immediate supervisors.\nComplete a Fishbone & Five Why’s\nNecessary Changes:\nNew or Changed Policies and Procedures based on Interviews, and the Five Why’s\nTraining:\nPersons to be trained\nObjectives\nContent\nPost Test\nSupervision and Employee Performance Evaluation:\nScheduled and Recorded Supervision –\nWho will supervise?\nWho will be supervised?\nWhen will supervision occur?\nWhat are expected behaviors?\nScheduled and Recorded Evaluation –\nWho will evaluate?\nWho will be evaluated?\nWhat are expected outcomes/behaviors?\nWhen will evaluations occur?\nAre the new or changed structures and processes effective and efficient?\nDemonstrate how the newly implemented actions will successfully eliminate the immediate threat of imminent harm by stating how the facility will regularly monitor in the short term (to establish compliance), and then, how long the facility will monitor periodically to monitor for sustained compliance. (Example: Audit new behavior every business day for two weeks, then one day per week for two weeks, then monthly for two months until 100% compliance is achieved.)\nIf IJ is not removed during the survey and an IJ removal plan is submitted, this will include a report of completed activities to be submitted to QUAD A prior to the first (IJ removal) revisit survey.\nImmediate Jeopardy Reporting Template\nDate/Time IJ Removal Plan provided to facility:","cbCaicbQtuVyN0Ls","https://ap.wps.com/l/cbCaicbQtuVyN0Ls","docx",1680447,"English","# Surveyor Responsibilities\n# Facility Steps\n## Root Cause Analysis\n## Necessary Changes\n## Training\n## Supervision and Employee Performance Evaluation\n## Monitoring and Reporting","[{\"question\":\"What must surveyors do if they agree that Immediate Jeopardy exists?\",\"answer\":\"Surveyors must immediately notify the facility by providing a completed IJ template and complete a preliminary IJ template identifying the specific noncompliance, the seriousness threshold, and the need for immediate action.\"},{\"question\":\"How is an IJ removal plan different from a Plan of Correction?\",\"answer\":\"An IJ removal plan must be developed instead of a Plan of Correction, while still containing the same core components.\"},{\"question\":\"What activities should be included in the IJ removal plan to address root causes?\",\"answer\":\"The plan should initiate root cause analysis by interviewing involved direct care staff and immediate supervisors and completing a fishbone diagram and Five Whys.\"}]","Immediate Jeopardy (IJ) Removal Plan Template - Instructions | DOCX"]