Advanced Dermatology And Skin Cancer

CLIA Laboratory Citation Details

4
Total Citations
12
Total Deficiencyies
9
Unique D-Tags
CMS Certification Number 44D1089309
Address 7658 Poplar Pike, Germantown, TN, 38138
City Germantown
State TN
Zip Code38138
Phone(901) 471-0660

Citation History (4 surveys)

Survey - May 7, 2025

Survey Type: Standard

Survey Event ID: 94MI11

Deficiency Tags: D3031 D5205

Summary:

Summary Statement of Deficiencies D3031 RETENTION REQUIREMENTS CFR(s): 493.1105(a)(3) Analytic systems records. Retain quality control and patient test records (including instrument printouts, if applicable) and records documenting all analytic systems activities specified in 493.1252 through 493.1289 for at least 2 years. In addition, retain the following: This STANDARD is not met as evidenced by: Based on patient record review and staff interview, the laboratory failed to retain the Mohs map for one of patients reviewed from 2024 and 2025. The findings include: 1. A review of patient Mohs records revealed that the Mohs map was not retained for one of four cases reviewed (patient identification number 5241M147084, Mohs case number 11261, performed on 02/18/25). 2. The laboratory liaison confirmed the survey findings during an interview on 05/07/25 at 9:30 a.m. D5205 COMPLAINT INVESTIGATIONS CFR(s): 493.1233 The laboratory must have a system in place to ensure that it documents all complaints and problems reported to the laboratory. The laboratory must conduct investigations of complaints, when appropriate. This STANDARD is not met as evidenced by: Based on direct observation, review of the procedure manual, and staff interview, the laboratory failed to have a process in place for investigating complaints on the survey date. The findings include: 1. Laboratory observation on 05/07/25 at 8:15 a.m. revealed equipment used for processing tissue removed during Mohs micrographic surgical procedures and a microscope used for reading histopathology slides. 2. A 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 -- review of the laboratory procedure manual revealed no policy, procedure, or process for investigating complaints related to laboratory testing. 3. The laboratory liaison confirmed the survey findings during an interview on 05/07/25 at 9:30 a.m. -- 2 of 2 --

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Survey - February 16, 2024

Survey Type: Standard

Survey Event ID: WPNT11

Deficiency Tags: D5217 D5475 D5793 D5473 D5475 D5793 D5407

Summary:

Summary Statement of Deficiencies D5217 EVALUATION OF PROFICIENCY TESTING PERFORMANCE CFR(s): 493.1236(c)(1) At least twice annually, the laboratory must verify the accuracy of any test or procedure it performs that is not included in subpart I of this part. This STANDARD is not met as evidenced by: Based on observation of the laboratory, review of patient records, lack of documentation, and staff interview, the laboratory failed to verify the accuracy of the Mart-1 immunohistochemistry (IHC) stain twice a year in 2022, 2023, and 2024. 1. Observation of the laboratory facility on 02/16/24 at 8:45 am revealed Mart-1 IHC reagents used for staining of tissue removed during Mohs surgical procedures. 2. Patient record review revealed the use of the Mart 1 IHC stain on 12/06/22 for patient MRN 26036, 10/10/23 for patient MRN 35465, and on 01/02/24 for patient MRN 10917. 3. There was no documentation that the Mart 1 IHC stain was verified for accuracy twice a year in 2022, 2023 or 2024. 4. The histotech stated during an interview on 02/16/24 at 11:00 AM that the laboratory did not send the Mart-1 IHC slides for twice a year verification of accuracy. This confirmed the survey findings. Word Key: MRN=Medical Record Number D5407 PROCEDURE MANUAL CFR(s): 493.1251(d) Procedures and changes in procedures must be approved, signed, and dated by the current laboratory director before use. This STANDARD is not met as evidenced by: Based on observation of the laboratory, patient test records, and staff interview, the laboratory procedure for performing Mart-1 immunohistochemical (IHC) staining was Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 3 -- not approved, signed or dated by the laboratory director. The laboratory used the Mart- 1 stain in 2022, 2023, and 2024. The findings include: 1. Observation of the laboratory facility on 02/16/24 at 8:45 AM revealed Mart-1 IHC reagents used for staining of tissue removed during Mohs surgical procedures. Observed taped to the wall were instructions for performing the stain that had not been approved, signed or dated by the laboratory director. There were multiple corrections to the instructions noted with no lab director approval. During the observation, the histotech stated the laboratory used the instructions taped to wall as their procedure. 2. Review of patient test records revealed the use of the Mart 1 IHC stain on 12/06/22 for patient MRN 26036, 10/10/23 for patient MRN 35465, and on 01/02/24 for patient MRN 10917. 3. Interview with the histotech on 02/16/24 at 11:00 AM confirmed the laboratory used the Mart-1 stain in 2022, 2023, and 2024 and did not have an approved procedure for performing the Mart-1 stain. D5473 CONTROL PROCEDURES CFR(s): 493.1256(e)(2)(g) (e) For reagent, media, and supply checks, the laboratory must do the following: (e) (2) Each day of use (unless otherwise specified in this subpart), test staining materials for intended reactivity to ensure predictable staining characteristics. Control materials for both positive and negative reactivity must be included, as appropriate. (g) The laboratory must document all control procedures performed. This STANDARD is not met as evidenced by: Based on observation of the laboratory, review of patient records, lack of documentation and staff interview, the laboratory failed to retain records of reagent and stain lot numbers and records that showed the acceptability of the stain/reagent lots prior to 08/01/2023. The findings include: 1. Observation of the laboratory on 02 /16/24 at 8:45 AM revealed stains (hematoxylin and eosin), reagents, and equipment used for preparing patient tissue removed during Mohs surgical procedure for microscopic examination. 2. Review of patient Mohs case numbers 9713 and 9996 revealed Mohs surgical procedures performed on 12/06/22 and 04/11/23. 3. Reagent /stain lot records were not maintained prior to 08/01/23. 4. During an interview on 02 /16/24 at 11 AM, the lead histotech stated that she had the records, but had discarded them. This confirmed the survey findings. D5475 CONTROL PROCEDURES CFR(s): 493.1256(e)(3)(g) (e) For reagent, media, and supply checks, the laboratory must do the following: (e) (3) Check fluorescent and immunohistochemical stains for positive and negative reactivity each time of use. (g) The laboratory must document all control procedures performed. This STANDARD is not met as evidenced by: Based on observation of the laboratory, review of patient test records, lack of documentation and staff interview, the laboratory failed to document the results of positive and negative controls for the Mart-1 (IHC) stain for three of three Mohs cases reviewed from 2022, 2023, and 2024, and failed to retain records of the Mart-1 reagent lot numbers and expiration dates. The findings include: 1. Observation of the laboratory facility on 02/16/24 at 8:45 AM revealed Mart-1 IHC reagents used for -- 2 of 3 -- staining of tissue removed during Mohs surgical procedures. 2. Review of patient test records revealed the use of the Mart-1 IHC stain on 12/06/22 for patient MRN 26036, 10/10/23 for patient MRN 35465, and on 01/02/24 for patient MRN 10917. The results of the positive and negative controls were not documented for any of the cases selected for review. 3. Historic reagent lot numbers and expiration dates for the reagents used in the Mart-1 IHC stain were not documented. 4. During an interview on 02/16/24 at 11:00 AM, the histotech confirmed the laboratory failed to document the results of the positive and negative controls for the Mart-1 stain in 2022, 2023 and 2024, and failed to retain records of lot numbers and expiration dates of the reagents used for performing the Mart-1 stain. D5793 ANALYTIC SYSTEMS QUALITY ASSESSMENT CFR(s): 493.1289(b)(c) (b) The analytic systems quality assessment must include a review of the effectiveness of

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Survey - July 22, 2022

Survey Type: Standard

Survey Event ID: EHJ411

Deficiency Tags: D5413 D5475

Summary:

Summary Statement of Deficiencies D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(b) The laboratory must define criteria for those conditions that are essential for proper storage of reagents and specimens, accurate and reliable test system operation, and test result reporting. The criteria must be consistent with the manufacturer's instructions, if provided. These conditions must be monitored and documented and, if applicable, include the following: (1) Water quality. (2) Temperature. (3) Humidity. (4) Protection of equipment and instruments from fluctuations and interruptions in electrical current that adversely affect patient test results and test reports. This STANDARD is not met as evidenced by: Based on observation of the laboratory, review of manufacturer package insert, document request and interview with the laboratory director, the laboratory failed to monitor the storage temperature of stains/reagents used in histopathology procedures. The findings include: 1. Virtual observation of the laboratory on 07/22/2022 at 8:30 am revealed Mart-1 one reagents/stains used in histopathology MOHS procedure stored in the refrigerator. 2. Review of the manufacturer package insert revealed that the reagents/stains are to be stored at 2-8 degrees Celsius. 3. Request made to the lead histotech on 07/22/2022 at 9 am for records of temperature monitoring for the refrigerator where the reagents were stored revealed no records were available. 4. Interview with the laboratory director on 07/22/2022 at 11:00 am confirmed the laboratory does not monitor the temperature of the refrigerator where the Mart-1 reagents/stains are stored. D5475 CONTROL PROCEDURES CFR(s): 493.1256(e)(3)(g) (e) For reagent, media, and supply checks, the laboratory must do the following: (e) (3) Check fluorescent and immunohistochemical stains for positive and negative 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 -- reactivity each time of use. (g) The laboratory must document all control procedures performed. This STANDARD is not met as evidenced by: Based on observation of the laboratory, review of manufacturer package insert, patient MOHS cases, document request, and interview with the laboratory director, the laboratory failed to document positive and negative control reactivity for three of three selected cases for use of the Mart-1 immunohistochemistry (IHC) stain in 2021 and 2022. The findings include: 1. Virtual observation of the laboratory on 07/22 /2022 at 8:30 am revealed Mart-1 IHC reagents/stains used in histopathology MOHS procedures stored in the refrigerator. 2. Review of the manufacturer package insert revealed that "Positive and negative controls should be run simultaneously with patient specimens." 3. Review of randomly selected patient MOHS procedures where the Mart-1 immunohistochemical stain was used revealed patient testing done on the following dates: Case #21G8673-Performed on 04/13/2021 Case #21G8760- Performed on 06/01/2021 Case #22G9455-Performed on 06/28/2022 4. Request on 07 /22/2022 at 10:30 am to the lead histotech for documentation of positive and negative control results for the selected cases revealed no documentation was present. 5. Virtual interview with the laboratory director on 07/22/2022 at 11:00 am confirmed the laboratory failed to document positive and negative reactivity for Mart-1 IHC stain for three of three selected dates/cases in 2021 and 2022. -- 2 of 2 --

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Survey - March 22, 2019

Survey Type: Standard

Survey Event ID: 0D9R11

Deficiency Tags: D6011

Summary:

Summary Statement of Deficiencies D6011 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1407(e)(2) The laboratory director is responsible for the overall operation and administration of the laboratory, including the employment of personnel who are competent to perform test procedures, and record and report test results promptly, accurate, and proficiently and for assuring compliance with the applicable regulations. (e) The laboratory director must-- (e)(2) and provide a safe environment in which employees are protected from physical, chemical, and biological hazards. This STANDARD is not met as evidenced by: Based on observation of the laboratory, review of the "Blood borne Pathogen Exposure Control Plan", and interview with processor number one, the laboratory director failed to ensure a safe environment for employees from biological hazards. The findings include: 1) Observation of the laboratory on March 22, 2019 at 10:26 a. m. revealed the laboratory area with four personal drinking containers in use on the counter. There were no biohazard safety signs and no 'No food or Drink Allowed' warning signs. 2) Review of the laboratory "Blood borne Pathogen Exposure Control Plan" revealed, "Training for the Exposure control Plan/Blood borne Pathogen must be provided for a new employee, an added/changed procedure and annually thereafter." 3) Interview on March 22, 2019 at 11:00 a.m. with processor number one confirmed the four containers of drinks on the laboratory counter next to the laptop computers. The "Blood borne Pathogen Exposure Control Plan" did not include a plan for biohazard safety. The employees did not have documented biohazard training. Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 1 --

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