Bend Dermatology Clinic Lab Llc

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 review of written records and discussion with staff, the laboratory failed to ensure testing personnel (TP)performing Potassium Hydroxide (KOH) mounts had bi- annual competency assessment. Finding include: 1. Upon review of the KOH log book, six (6) out of seven (7) providers performing KOH mounts did not have any peer review or competency assessment for 2019 and 2020. 2. This finding was confirmed by staff during interview 08/18/2020 at approximately 1130 a.m. 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 --

Summary Statement of Deficiencies D6120 TECHNICAL SUPERVISOR RESPONSIBILITIES CFR(s): 493.1451(b)(7)(8) (7) The technical supervisor is responsible for identifying training needs and assuring that each individual performing tests receives regular in-service training and education appropriate for the type and complexity of the laboratory services performed; (8) Evaluating the competency of all testing personnel and assuring that the staff maintain their competency to perform test procedures and report test results promptly, accurately and proficiently. This STANDARD is not met as evidenced by: Review of competency records and discussion with the staff the Laboratory Director who also served as the Technical Supervisor failed to assess and document competency testing of the testing personnels. Findings include. 1. 4 out of 4 testing pesonnel who are dermatologist do not have documentations of annual competency evaluation for the year 2016, 2017 and 2018. Last competency documentations was 04 /14/2015. 2. This fnding was confirmed by the Histology staff on 06/26/2018 at 11: 30AM. 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 --