A2cl-Aurora Health Center Manitowoc County

CLIA Laboratory Citation Details

3
Total Citations
9
Total Deficiencyies
5
Unique D-Tags
CMS Certification Number 52D1021288
Address 5300 Memorial Drive-Attn Lab Supervisor, Two Rivers, WI, 54241
City Two Rivers
State WI
Zip Code54241
Phone(920) 794-5000

Citation History (3 surveys)

Survey - September 24, 2025

Survey Type: Standard

Survey Event ID: 3U1Z11

Deficiency Tags: D6010 D2006 D6010

Summary:

Summary Statement of Deficiencies D2006 TESTING OF PROFICIENCY TESTING SAMPLES CFR(s): 493.801(b) (b)The laboratory must examine or test, as applicable, the proficiency testing samples it receives from the proficiency testing program in the same manner as it tests patient specimens. This testing must be conducted in conformance with paragraph (b)(4) of this section. If the laboratory's patient specimen testing procedures would normally require reflex, distributive, or confirmatory testing at another laboratory, the laboratory should test the proficiency testing sample as it would a patient specimen up until the point it would refer a patient specimen to a second laboratory for any form of further testing. This STANDARD is not met as evidenced by: Based on surveyor review of laboratory records generated for submission to the Wisconsin State Laboratory of Hygiene (WSLH) proficiency testing (PT) program, patient records, and interview with a general supervisor (staff A), the laboratory did not perform testing on PT samples for electrolyte tests in the same manner as it tests patient samples for one of two general chemistry events completed to date in 2025. Findings include: 1. Review of laboratory records generated for general chemistry PT event one of 2025, revealed the laboratory had performed electrolyte testing on the PT samples on March 19, 2025, and repeated the tests on March 21, 2025, after completion of required instrument servicing due to an Integrated Multisensor Technology (IMT) measurement error. The laboratory reported the electrolyte results from March 21, 2025, to the WSLH PT program, after completion of instrument servicing. 2. Review of laboratory patient records revealed 61 patient samples had electrolyte testing performed and resulted between March 19, 2025, and March 20, 2025. 3. Interview with staff A on September 24, 2025, at 10:45 AM, confirmed the laboratory repeated PT sample testing for electrolytes after servicing was performed on the instrument and submitted the repeated results to the PT program, but continued Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 2 -- to perform and report electrolytes for patients during the same period of time, confirming the laboratory did not test PT samples in the same manner as it tests patient samples. D6010 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1407(e)(2) (e)(2) Ensure that the physical plant and environmental conditions of the laboratory are appropriate for the testing performed and This STANDARD is not met as evidenced by: Based on surveyor review of documented humidity readings in the laboratory and interview with a general supervisor (staff A), the laboratory director did not ensure the humidity in the laboratory was appropriate for the testing performed on the Sysmex XN-450 and Dimension Xpand Plus analyzers for 21 out of 31 days in December 2024. Findings include: 1. Review of the "Monthly Report" for the "Manit MOB Humidity" sensor from the laboratory's continuous temperature monitoring system, SensoScientific, revealed the average relative humidity reading was less than 20% for 21 out of 31 days in December 2024. 2. Review of the performance specifications for the Sysmex XN-450 and Dimension Xpand Plus revealed the relative humidity requirements were 20-85% and 20-80%, respectively. 3. Interview with staff A on September 24, 2025, at 2:00 PM, confirmed the relative humidity readings seen on the SensoScientific report were outside the relative humidity requirements for the Sysmex XN-450 and Dimension Xpand Plus analyzers, and that the laboratory director did not ensure the laboratory could maintain appropriate humidity levels as defined by the analyzers' manufacturers during patient testing. -- 2 of 2 --

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Survey - December 21, 2021

Survey Type: Standard

Survey Event ID: Y21211

Deficiency Tags: D5439 D5439

Summary:

Summary Statement of Deficiencies D5439 CALIBRATION AND CALIBRATION VERIFICATION CFR(s): 493.1255(b) Unless otherwise specified in this subpart, for each applicable test system the laboratory must do the following: Perform and document calibration verification procedure - (b)(1) Following the manufacturer's calibration verification instructions; (b)(2) Using the criteria verified or established by the laboratory under 493.1253(b)(3) -- (b)(2)(i) Including the number, type, and concentration of the materials, as well as acceptable limits for calibration verification; and (b)(2)(ii) Including at least a minimal (or zero) value, a mid-point value, and a maximum value near the upper limit of the range to verify the laboratory's reportable range of test results for the test system; and (b)(3) At least once every 6 months and whenever any of the following occur: (b)(3)(i) A complete change of reagents for a procedure is introduced, unless the laboratory can demonstrate that changing reagent lot numbers does not affect the range used to report patient test results, and control values are not adversely affected by reagent lot number changes. (b)(3)(ii) There is major preventive maintenance or replacement of critical parts that may influence test performance. (b)(3)(iii) Control materials reflect an unusual trend or shift, or are outside of the laboratory's acceptable limits, and other means of assessing and correcting unacceptable control values fail to identify and correct the problem. (b)(3)(iv) The laboratory's established schedule for verifying the reportable range for patient test results requires more frequent calibration verification. This STANDARD is not met as evidenced by: Based on surveyor review of laboratory records and interview with the technical consultant, the laboratory did not perform and document calibration verification procedures for five chemistry analytes at least once every 6 months twice in the last two years. Findings include: 1. Review of chemistry calibration verification records show calibration verification was performed for Sodium (Na), Potassium (K), Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 2 -- Chloride (Cl), Calcium (Ca) and aspartate aminotransferase (AST) in December 2019, June 11, 2020, and January 14, 2021. 2. Interview with the technical consultant on December 21, 2021 at 1:00 PM confirmed the January 2021 calibration verification was more than six months after the previous occurrence and that calibration verification had not been performed within six months after the January 14, 2021 event. -- 2 of 2 --

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Survey - January 14, 2020

Survey Type: Standard

Survey Event ID: JT3U11

Deficiency Tags: D5445 D5545 D5445 D5545

Summary:

Summary Statement of Deficiencies D5445 CONTROL PROCEDURES CFR(s): 493.1256(d)(1)(2)(g) Unless CMS Approves a procedure, specified in Appendix C of the State Operations Manual (CMS Pub. 7), that provides equivalent quality testing, the laboratory must-- (d)(1) Perform control procedures as defined in this section unless otherwise specified in the additional specialty and subspecialty requirements at 493.1261 through 493.1278. (d)(2) For each test system, perform control procedures using the number and frequency specified by the manufacturer or established by the laboratory when they meet or exceed the requirements in paragraph (d)(3) of this section. (g) The laboratory must document all control procedures performed. This STANDARD is not met as evidenced by: Based on surveyor review of quality control records, patient test logs, Individualized Quality Control Plan (IQCP) and interview with the general supervisor, the laboratory did not perform quality control prior to reporting patient results on serum human chorionic gonadotropin (HCG) testing with lot# 704702. Findings include: 1. Review of quality control records from September and October 2019 showed the laboratory performed serum HCG quality control on Lot# 704702 on September 14, 2019. 2. Review of serum HCG patient test logs revealed the laboratory performed testing on Patient 1 using Lot# 704702 on October 22, 2019. 3. Review of serum HCG IQCP showed the laboratory required quality control every 30 days and/or with each new shipment/lot. 4. Interview with the general supervisor on January 14, 2020 at 1:29 PM confirmed the laboratory did not perform quality control on the serum HCG test prior to reporting patient results using Lot# 704702 as indicated in their IQCP quality control plan. D5545 HEMATOLOGY CFR(s): 493.1269(b)(d) Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 2 -- (b) For all nonmanual coagulation test systems, the laboratory must include two levels of control material each 8 hours of operation and each time a reagent is changed. (d) The laboratory must document all control procedures performed, as specified in this section. This STANDARD is not met as evidenced by: Based on surveyor review of Siemens CA-660 coagulation analyzer printouts and interview with the general supervisor, the laboratory did not perform quality control (QC) each eight hours of operation on the coagulation analyzer on two days in December 2019 and January 2020. Findings include: 1. Review of Siemens CA-660 printout revealed: On December 16, 2019, QC performed at 8:33 AM, Patient 2 testing performed at 5:01 PM. No additional QC performed between the two times. On January 6, 2020, QC performed at 8:51 AM, Patient 3 testing performed at 5:27 PM. No additional QC performed between the two times. 2. Interview with the general supervisor on January 14, 2020 at 1:07 PM confirmed the laboratory did not perform quality control each eight hours of operation prior to patient testing on the Siemens CA-660 coagulation analyzer. -- 2 of 2 --

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