It is a concern to providers that the provider has a time frame for responding to the CAP, but the department does not.  Often, it is unclear what the status of a CAP that was submitted is because it has not been returned.  We rarely receive a notification that it has been accepted.  If the provider does not agree with the department and wishes to appeal, there is generally a time of conversation which includes resubmitting.  It is a burden on the provider that during this process, and prior to appeal, another CAP would be issued.  The CAP should be a tool for improvement of services, not a punishment.  This guidance document makes the process punitive rather than cooperative.  It appears that rather than helping the provider improve services, the approach is to add citations.    

It is appropriate to cite issues during a review, such as a minor maintenance issue.  For larger providers with multiple locations, the ability to ensure that at the exact moment a reviewer visits a program, something may have just happened and the staff members have not had the opportunity to repair it.   Again, this is appropriate to note and even cite, but to call it "systemic" is not necessarily reasonable.   The issue may not be that there is a need for new policy or retraining so much as just to fix that issue, such as perform a repair.