170 H 

The provider shall monitor implementation and effectiveness of approved corrective actions as part of its quality improvement program required by 12VAC35-105-620. If the provider determines that an approved corrective action was fully implemented, but did not prevent the recurrence of a regulatory  violation or correct any systemic deficiencies, the provider shall:

1. Continue implementing the corrective action plan and put into place additional measures to prevent the recurrence of the cited violation and address identified systemic deficiencies; or

2. Submit a revised corrective action plan to the department for approval. ]

Also 620 D.3

Submit revised corrective action plans to the department for approval or continue implementing the corrective action plan and put into place additional measures to prevent the recurrence of the cited violation and address identified systemic deficiencies when reviews determine that a corrective action was fully implemented but did not prevent the recurrence of the cited regulatory violation or correct a systemic deficiency pursuant to 12VAC35-105-170.

Provider does not disagree with the idea of monitoring effectiveness of approved corrective action plans or submitting a revised corrective action plan should the corrective action plan not appear to be effective.  Provider’s issue lies with assumption that a fully implemented plan would always prevent the recurrence of a violation, and that failure to do so requires a systemic plan – some issues that are included on a corrective action plan may not be something that a provider can guarantee won’t occur again regardless of the plan of action put in place.  This seems an impossible standard to meet. 

280 F 

Adequate hot and cold running water of a safe and appropriate temperature shall be available.  Hot water accessible to Individuals being served shall be maintained within a range of 100-110°F.  If temperatures cannot be maintained within the specific range, the provider shall make provisions for protecting Individuals from injury due to scalding.

Provider takes issue with the temperature range allowed in these regulations.  A maximum water temperature of 110 degrees is not sufficient to kill bacteria (Legionella bacteria, for example, in fact thrives at this temperature).  Licensing has in the past recommended a master mixing valve placed at the water heater as a solution, but mixing valves typically only reduce the water temperature to 120 degrees, per ASSE guidelines (still above the maximum required temperature).  And again, water heated only to 110 degrees is not sufficient to kill bacteria.