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.    

I am also concerned that providers have a time frame for responding to a CAP, but the department does not.  Often, the status of a submitted CAP is unclear because it has not been returned.  Notifications that a CAP has been accepted do not often occur.  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.

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, it is appropriate to note or cited the issue, 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.