Anne Arundel Dermatology, Pa

CLIA Laboratory Citation Details

4
Total Citations
13
Total Deficiencyies
11
Unique D-Tags
CMS Certification Number 44D0312905
Address 123 Fox Rd, Knoxville, TN, 37922
City Knoxville
State TN
Zip Code37922
Phone(865) 332-1274

Citation History (4 surveys)

Survey - February 13, 2025

Survey Type: Standard

Survey Event ID: 6GF311

Deficiency Tags: D5417 D5415

Summary:

Summary Statement of Deficiencies D5415 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(c) (c) Reagents, solutions, culture media, control materials, calibration materials, and other supplies, as appropriate, must be labeled to indicate the following: (c)(1) Identity and when significant, titer, strength or concentration. (c)(2) Storage requirements. (c)(3) Preparation and expiration dates. (c)(4) Other pertinent information required for proper use. This STANDARD is not met as evidenced by: Based on observation of laboratory and staff interviews, the laboratory failed to label reagents used in the Histopathology tissue processing laboratory with information when transferred from the primary to the secondary container. The findings include: 1. Observation of the Histology laboratory on 02.11.2025 at 9:00 a.m. revealed a secondary container used for processing samples for Histopathology procedures that was not labeled with identity, lot number, and expiration date when transferred from the original container to the secondary container. The reagent was verbally identified as Nail Prep (Item #NP-500) by histology laboratory supervisor. 2. An interview with the histology laboratory supervisor on 02.11.2025 at 09:00 a.m. confirmed the survey findings. D5417 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(d) (d) Reagents, solutions, culture media, control materials, calibration materials, and other supplies must not be used when they have exceeded their expiration date, have deteriorated, or are of substandard quality. This STANDARD is not met as evidenced by: 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 -- Citation One: Based on observation of the Histology laboratory and staff interview, the laboratory failed to ensure that tissue marking dyes and hematoxylin used for inking and staining had not expired on the date of the survey (02.11.2025). The findings include: 1. Observation of the Histology laboratory on 02.11.2025 at 9:00 am revealed the following expired dyes and stains in use. -Mercedes Scientific Tissue Marking Dye Red (2 bottles), lot number 23004, expiration date 01.31.2025 - Modified Mayers Hematoxylin (1 bottle), lot number 181170, expiration date 10.31.2024. 2. An interview with the Histology laboratory supervisor on 02.11.2025 at 09:03 a.m. confirmed the above findings. Citation Two: Based on observation of the MOHS processing room and staff interview, the laboratory failed to ensure it did not use tissue marking dyes for MOHS Histopathology tissue processing past their expiration date on the survey date (02.11.2025). The finding include: 1. Observation of the MOHS processing room on 02.11.2025 at 9:39 a.m. revealed the following tisse marking dyes in use. -Cancer Diagnostic, Inc. Tissue Marking Dyes (2 bottles) Orange, lot number 21111, expiration date 04.30.2023. Green, lot number 21130, expiration date 05.31.2023. 2. Interview with the MOHS technician on 02.11.2025 at 9:39 a.m. confirmed the above findings. Work Key: MOHS: micrographically oriented histography surgery -- 2 of 2 --

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Survey - February 11, 2025

Survey Type: Complaint

Survey Event ID: LUOP11

Deficiency Tags: D5401

Summary:

Summary Statement of Deficiencies D5401 PROCEDURE MANUAL CFR(s): 493.1251(a) (a) A written procedures manual for all tests, assays, and examinations performed by the laboratory must be available to, and followed by, laboratory personnel. Textbooks may supplement but not replace the laboratory's written procedures for testing or examining specimens. This STANDARD is not met as evidenced by: Intakes: TN00073355 Based on observation of the laboratory, a review of the laboratory procedure manual, and an interview with the histology laboratory supervisor, it was determined that the laboratory failed to follow the Standard Operating Procedure Manual for labeling chemical reagents. The findings include: 1. Observation of the laboratory on 02.11.2025 at 09:13 a.m. revealed a flammable cabinet with three containers of unlabeled substance, verbally identified as Xylene waste by histology laboratory supervisor. 2. A review of the laboratory's Standard Operating Procedure Manual under " Storage, use and handling" revealed the following: "All reagents are stored according to manufacturer's guidelines along with all state and federal Guidelines and are kept in a flammable cabinet. If chemicals are expired they are not used and disposed of. All chemicals are labeled clearly on outside of all bottles. Material safety data sheets are in the back of binder for reference." 3. An interview with the histology laboratory supervisor on 02.11.2025 at 09:13 a.m. confirmed the findings. 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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Survey - June 23, 2023

Survey Type: Standard

Survey Event ID: GLT111

Deficiency Tags: D5415 D6121 D5403 D5417 D6124 D5413 D5473 D6126

Summary:

Summary Statement of Deficiencies D5403 PROCEDURE MANUAL CFR(s): 493.1251(b) The procedure manual must include the following when applicable to the test procedure: (1) Requirements for patient preparation; specimen collection, labeling, storage, preservation, transportation, processing, and referral; and criteria for specimen acceptability and rejection as described in 493.1242. (2) Microscopic examination, including the detection of inadequately prepared slides. (3) Step-by-step performance of the procedure, including test calculations and interpretation of results. (4) Preparation of slides, solutions, calibrators, controls, reagents, stains, and other materials used in testing. (5) Calibration and calibration verification procedures. (6) The reportable range for test results for the test system as established or verified in 493.1253. (7) Control procedures. (8)

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Survey - February 7, 2022

Survey Type: Standard

Survey Event ID: Q3Q511

Deficiency Tags: D5217 D6171

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 lack of twice a year accuracy verification for peer slide review and interview with the Lead Histotechnician, determined the laboratory failed to verify peer slide review accuracy twice a year in 2020 and 2021. The findings include: 1. A lack of twice a year accuracy verification for peer slide review for 2020 and 2021. 2. An interview with the Lead Histotechnician at approximately 12:30 pm on February 7, 2022 confirmed only one peer slide review accuracy verification had been documented for 2020 and one peer slide review for 2021. ================================== D6171 TESTING PERSONNEL QUALIFICATIONS CFR(s): 493.1489(b) (b) Meet one of the following requirements: (b)(1) Be a doctor of medicine, doctor of osteopathy, or doctor of podiatric medicine licensed to practice medicine, osteopathy, or podiatry in the State in which the laboratory is located or have earned a doctoral, master's or bachelor's degree in a chemical, physical, biological or clinical laboratory science, or medical technology from an accredited institution; (b)(2)(i) Have earned an associate degree in a laboratory science, or medical laboratory technology from an accredited institution or-- (b)(2)(ii) Have education and training equivalent to that specified in paragraph (b)(2)(i) of this section that includes-- (b)(2)(ii)(A) At least 60 semester hours, or equivalent, from an accredited institution that, at a minimum, include either-- (b)(2)(ii)(A)(1) 24 semester hours of medical laboratory technology courses; or (b)(2)(ii)(A)(2) 24 semester hours of science courses that include-- (b)(2) 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 -- (ii)(A)(2)(i) Six semester hours of chemistry; (b)(2)(ii)(A)(2)(ii) Six semester hours of biology; and (b)(2)(ii)(A)(2)(iii) Twelve semester hours of chemistry, biology, or medical laboratory technology in any combination; and (b)(2)(ii)(B) Have laboratory training that includes either of the following: (b)(2)(ii)(B)(1) Completion of a clinical laboratory training program approved or accredited by the ABHES, the CAHEA, or other organization approved by HHS. (This training may be included in the 60 semester hours listed in paragraph (b)(2)(ii)(A) of this section.) (b)(2)(ii)(B)(2) At least 3 months documented laboratory training in each specialty in which the individual performs high complexity testing. (b)(3) Have previously qualified or could have qualified as a technologist under 493.1491 on or before February 28, 1992; (b) (4) On or before April 24, 1995 be a high school graduate or equivalent and have either-- (b)(4)(i) Graduated from a medical laboratory or clinical laboratory training program approved or accredited by ABHES, CAHEA, or other organization approved by HHS; or (b)(4)(ii) Successfully completed an official U.S. military medical laboratory procedures training course of at least 50 weeks duration and have held the military enlisted occupational specialty of Medical Laboratory Specialist (Laboratory Technician); (b)(5)(i) Until September 1, 1997-- (b)(5)(i)(A) Have earned a high school diploma or equivalent; and (b)(5)(i)(B) Have documentation of training appropriate for the testing performed before analyzing patient specimens. Such training must ensure that the individual has-- (b)(5)(i)(B)(1) The skills required for proper specimen collection, including patient preparation, if applicable, labeling, handling, preservation or fixation, processing or preparation, transportation and storage of specimens; (b)(5)(i)(B)(2) The skills required for implementing all standard laboratory procedures; (b)(5)(i)(B)(3) The skills required for performing each test method and for proper instrument use; (b)(5)(i)(B)(4) The skills required for performing preventive maintenance, troubleshooting, and calibration procedures related to each test performed; (b)(5)(i)(B)(5) A working knowledge of reagent stability and storage; (b)(5)(i)(B)(6) The skills required to implement the quality control policies and procedures of the laboratory; (b)(5)(i)(B)(7) An awareness of the factors that influence test results; and (b)(5)(i)(B)(8) The skills required to assess and verify the validity of patient test results through the evaluation of quality control values before reporting patient test results; and (b)(5)(i)(B)(8)(ii) As of September 1, 1997, be qualified under 493.1489(b)(1), (b)(2), or (b)(4), except for those individuals qualified under paragraph (b)(5)(i) of this section who were performing high complexity testing on or before April 24, 1995; (b)(6) For blood gas analysis-- (b)(6) (i) Be qualified under 493.1489(b)(1), (b)(2), (b)(3), (b)(4), or (b)(5); (b)(6)(ii) Have earned a bachelor's degree in respiratory therapy or cardiovascular technology from an accredited institution; or (b)(6)(iii) Have earned an associate degree related to pulmonary function from an accredited institution; or (b)(7) For histopathology, meet the qualifications of 493.1449 (b) or (l) to perform tissue examinations. This STANDARD is not met as evidenced by: ================================== Based on observation of the laboratory, interview with the Lead Histotechnician, and review of testing personnel education documents, testing personnel number four and five listed on the Center for Medicare and Medicaid Services Personnel Report (CMS-209) failed to meet the high complexity regulatory education requirements for performing grossing of tissue removed during Histopathology procedures in August 2021 through February 7, 2022. The findings include: 1. Observation of the laboratory on February 7, 2022 at 9:30 am revealed grossing stations in use for histopathology testing procedures. 2. Interview with Lead Histotechnician on February 7, 2022 at 11:30 am revealed that testing personnel number four and five perform grossing of tissue removed during -- 2 of 3 -- Histopathology procedures. 3. Review of education documents for testing personnel number four and five revealed that testing personnel number four and five did not meet the minimum education requirements for performing high complexity testing for performing grossing of tissue removed during Histopathology procedures in August 2021 through February 7, 2022. ================================== -- 3 of 3 --

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