Differentiating Between Deficiencies

Differentiating between deficiencies or violations that represent a breakdown in a system and those that represent a discrete problem is not always easy, but if the facility does not identify the source of the failure, it probably will not succeed in correcting it.

 

Here is an example of a deficiency. How would you determine whether this is a system failure or a discrete failure?

 

W473  483.480(b)(2)(ii), Food must be served – at appropriate temperature.

Based on observations and interviews, the facility failed to ensure that hot food was served at an appropriate temperature for 6 of 6 individuals (Individuals #'s 1 – 6).

A summary of the findings includes: