05/21/2026

Survey Tip of the Week: Hot Water Temperatures

An immediate jeopardy citation can occur when a resident receives a burn as a result of hot water from faucets and hot liquids served during meals. Hand sinks, showers, tubs, and any other source where residents have access to hot water may create a risk for burns and scald injuries. Surveyors will review whether facilities have systems in place to prevent avoidable injuries related to water temperatures under State Operations Manual Appendix PP F689 (Free of Accident Hazards/Supervision/Devices). 

CMS notes that nursing home residents are at increased risk for scald injuries due to conditions such as decreased skin thickness, reduced skin sensitivity, peripheral neuropathy, impaired mobility, slower reaction time, dementia, and limited ability to communicate discomfort. Even short exposure times can result in significant injury depending on the temperature of the water and the resident’s condition. 

The SOM Appendix PP highlights the relationship between water temperature and the amount of time required for a serious burn to occur, from 1 second at 155 degrees Fahrenheit to 5 minutes at 120 degrees Fahrenheit. The guidance also notes that burns can occur even at temperatures below those listed in the manual depending on the individual resident and the duration of exposure. 

During the Long-Term Care Survey Process, surveyors may evaluate: 

• Whether the facility routinely monitors hot water temperatures.  

• Whether residents with cognitive impairment, sensory deficits, or mobility limitations have increased supervision or interventions related to hot water exposure.  

• Whether the facility responds appropriately to residents’ complaints regarding water temperature.  

• Whether adaptive equipment, mixing valves, or other engineering controls are in place when indicated.  

• Whether incidents involving burns or scalds were investigated through the facility’s QAPI process.  

Facilities should also remember that hot liquid burns are not limited to bathing or sink water. Coffee, soups, and other heated liquids may also create scald risks depending on the resident population being served. Facilities should monitor temperatures following water heater repairs, maintenance, or replacement. Adjustments to water heaters or thermostatic mixing valves can unexpectedly increase outlet water temperatures throughout the building. Facilities should consider implementing a process to verify and document water temperatures after maintenance activities are completed and ensure mixing valves are functioning properly to maintain safe delivery temperatures at resident use locations.