Associates In Dermatology Inc

CLIA Laboratory Citation Details

3
Total Citations
7
Total Deficiencyies
4
Unique D-Tags
CMS Certification Number 36D1039033
Address 2205 Crocker Rd, Suite 109, Westlake, OH, 44145
City Westlake
State OH
Zip Code44145
Phone(440) 482-8323

Citation History (3 surveys)

Survey - November 7, 2023

Survey Type: Standard

Survey Event ID: 894U11

Deficiency Tags: D5407

Summary:

Summary Statement of Deficiencies 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 record review and an interview with the CLIA Coordinator (CC), the Laboratory Director failed to ensure that policies and procedures for high complexity tissue slide interpretation testing procedures for the dermatopathology professional component in the subspecialty of Histopathology were approved via signature and date before implementation. This deficient practice had the potential to affect 971 out of 971 tissue biopsy interpretations performed between 11/17/2021 through 11/07 /2023. Findings Include: 1. Review of the laboratory's "Dermatopath/Histo CLIA Manual", provided on the date of the inspection, did not find the Laboratory Director's approval via signature and date. 2. Further review of the laboratory's "Dermatopath /Histo CLIA Manual", revealed Testing Personnel #3 signed and dated the policies and procedures for the professional component of dermatopathology. 3. The CC confirmed the Laboratory Director did not approve the laboratory's policies and procedures in the "Dermatopath/Histo CLIA Manual" prior to implementing the high complexity tissue biopsy slide interpretation testing procedures performed. The interview occurred on 11/07/2023 at 1:15 PM. 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 - November 17, 2021

Survey Type: Standard

Survey Event ID: VT9T11

Deficiency Tags: D5209 D6107 D5209 D6107

Summary:

Summary Statement of Deficiencies D5209 PERSONNEL COMPETENCY ASSESSMENT POLICIES CFR(s): 493.1235 As specified in the personnel requirements in subpart M, the laboratory must establish and follow written policies and procedures to assess employee and, if applicable, consultant competency. This STANDARD is not met as evidenced by: Based on record review, and an interview with the CLIA Coordinator, the laboratory failed to follow a written policy and procedure to assess competency of the Clinical Consultant (CC) as specified in the personnel requirements in subpart M. All patients tested at this laboratory had the potential to be affected. Findings Include: 1. A virtual review of the laboratory's CMS-209 Personnel Report form, approved and signed by the Lab Director on 11/22/2021, found five individuals that fulfilled the role of the CC, other than the Lab Director (LD) 2. A virtual review of the laboratory's "Personnel Training Policy and Procedure found the following statement: "...2. The Clinical Team Lead will monitor that the Lab Director has provided and documented the training of the Clinical Consultant (CC} and Testing Personnel (TP) on an annual basis while performing the bi-annual QA reviews...." 3. A virtual review of the laboratory's Competency Assessment documentation, failed to find evidence that the five delegated CCs were assessed for competency, based on the regulatory responsibility of that role, at a frequency determined by the laboratory. 4. A video phone call interview with the CLIA Coordinator, on 11/17/2021 at 1:42 PM, confirmed that the lab failed to follow the policy and procedure for assessing and documenting the competency of the CC based on the regulatory responsibility of that role, at a frequency determined by the laboratory. Thus the documentation could not be produced at the time of the inspection. D6107 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1445(e)(15) 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 -- The laboratory director must specify, in writing, the responsibilities and duties of each consultant and each supervisor, as well as each person engaged in the performance of the preanalytic, analytic, and postanalytic phases of testing, that identifies which examinations and procedures each individual is authorized to perform, whether supervision is required for specimen processing, test performance or result reporting and whether supervisory or director review is required prior to reporting patient test results. This STANDARD is not met as evidenced by: Based upon a record review and an interview with the CLIA Coordinator, the Laboratory Director (LD) failed to specify the duties and responsibilities of the Clinical Consultants (CC) listed on the CMS-209. All patients tested at this laboratory had the potential to be affected. Findings include: 1. A virtual review of the laboratory's CMS-209 Personnel Report form, approved and signed by the Lab Director on 11/22/2021, found five individuals that fulfilled the role of the CC, other than the Lab Director (LD). 2. A virtual review of policies and procedures failed to find evidence that the duties and responsibilities of the CC were specified in writing, with regulatory responsibilities delegated to those individuals by the LD. 3. A video phone call interview with the CLIA Coordinator on 11/17/2021 at 1:42 PM, confirmed that the LD failed to specify in writing, the regulatory responsibilities of the five CCs, delegated to those individuals by the LD. Thus, the documentation could not be produced at the time of the inspection. -- 2 of 2 --

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Survey - August 13, 2019

Survey Type: Standard

Survey Event ID: 0KTW11

Deficiency Tags: D5805 D5805

Summary:

Summary Statement of Deficiencies D5805 TEST REPORT CFR(s): 493.1291(c) The test report must indicate the following: (c)(1) For positive patient identification, either the patient's name and identification number, or a unique patient identifier and identification number. (c)(2) The name and address of the laboratory location where the test was performed. (c)(3) The test report date. (c)(4) The test performed. (c)(5) Specimen source, when appropriate. (c)(6) The test result and, if applicable, the units of measurement or interpretation, or both. (c)(7) Any information regarding the condition and disposition of specimens that do not meet the laboratory's criteria for acceptability. This STANDARD is not met as evidenced by: Based on record review and an interview with the Clinical Team Lead, the laboratory failed to indicate, on 4 out of 7 final test reports, an accurate specimen source for each KOH (potassium hydroxide) procedure performed. This deficient practice had the potential to affect all patients tested under the subspecialty of mycology. Findings Include: The Surveyor reviewed 7 final test reports for KOH. 1. Review of 4 of the 7 KOH final test reports found the following specimen sources: Date Patient Source 10- 10-17 291480 "right heel" 1-15-18 866880 "scalp right upper thigh" 3-7-18 620040 "right foot" 8-22-18 52816 "right lateral foot" 2. Review of the 4 corresponding KOH interim test records listed on the "KOH and Scabies prep log" found the following specimen sources: Date Patient Source 10-10-17 291480 "R. lower leg" 1-15-18 866880 "R. thigh" 3-7-18 620040 "lf foot" 8-22-18 528160 "L foot" 3. An interview with the Clinical Team Lead, on 8/12/19 at 11:29 am, confirmed the specimen sources listed on the final test report were not the same as the specimen sources listed on the test records, and thus, were not accurate. 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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