Beulaville Pediatrics

CLIA Laboratory Citation Details

2
Total Citations
6
Total Deficiencyies
3
Unique D-Tags
CMS Certification Number 34D0983971
Address 110 East Park Drive, Beulaville, NC, 28518
City Beulaville
State NC
Zip Code28518
Phone910 298-6558
Lab DirectorCAROL RIDDLE

Citation History (2 surveys)

Survey - February 8, 2023

Survey Type: Standard

Survey Event ID: OEDV11

Deficiency Tags: D5415 D5429 D5415 D5429

Summary:

Summary Statement of Deficiencies D5415 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(c) Reagents, solutions, culture media, control materials, calibration materials, and other supplies, as appropriate, must be labeled to indicate the following: (1) Identity and when significant, titer, strength or concentration. (2) Storage requirements. (3) Preparation and expiration dates. (4) Other pertinent information required for proper use. This STANDARD is not met as evidenced by: Based on manufacturer's instructions, surveyor observation and laboratory director (LD) interview 2/8/22 the laboratory failed to label 3 vials of hematology quality control (QC) reagent with current expiration dates. Findings: Review of manufacturer's instructions for Boule Con-Diff Tri-Level hematology QC reagent revealed "Storage and Stability...Open vial stability 14 days after opening when returned to refrigerator after each use. ". At approximately 11:00 p.m. surveyor observed a plastic container on the top shelf in laboratory refrigerator containing 3 vials of Boule Con-Diff Tri-Level hematology QC reagent, Lot #22212-33,22212-32 and 2212-31. The 3 vials of QC reagent failed to be labeled with current expiration dates. Interview with LD at approximately 11:00 a.m. confirmed the 3 vials of QC reagent were not labeled with current expiration dates. She stated the vials were put into use this morning and demonstrated that they track the date in which new QC reagents are put into use on a calendar beside the hematology instrument. She also confirmed the 3 vials were not labeled with current expiration dates. D5429 MAINTENANCE AND FUNCTION CHECKS CFR(s): 493.1254(a)(1) For unmodified manufacturer's equipment, instruments, or test systems, the laboratory must perform and document maintenance as defined by the manufacturer and with at 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 -- least the frequency specified by the manufacturer. This STANDARD is not met as evidenced by: Based on review of Medonic hematology analyzer user manual, review of 2021, 2022 and 2023 Medonic maintenance logs and interview with LD 2/8/22, the laboratory failed to document monthly maintenance of the Medonic hematology analyzer since testing began in November of 2021, a period of approximately fourteen months. Findings: Review of Medonic user manual revealed under Section 8.2 "Monthly Cleaning...This section describes the cleaning procedures to be used to secure the correct function of the instrument on a monthly basis.". Review of Medonic maintenance logs for 2021, 2022 and 2023 revealed no documentation of the performance of monthly maintenance since testing began in November of 2021. Interview with LD at approximately 11:00 a.m. confirmed monthly maintenance was not documented. She stated she was sure the maintenance was performed because the instrument would not allow testing if not. -- 2 of 2 --

πŸ”’ Unlock Deficiency Summary

Get full access to the detailed deficiency summary for this facility

One-time payment β€’ Lifetime access

Survey - October 29, 2019

Survey Type: Standard

Survey Event ID: BEN011

Deficiency Tags: D2007 D2007

Summary:

Summary Statement of Deficiencies D2007 TESTING OF PROFICIENCY TESTING SAMPLES CFR(s): 493.801(b)(1) The samples must be examined or tested with the laboratory's regular patient workload by personnel who routinely perform the testing in the laboratory, using the laboratory's routine methods This STANDARD is not met as evidenced by: Based on review laboratory procedure manual, review of Medical Laboratory Evaluation (MLE) proficiency testing (PT) records and interview with testing personnel (TP) 10/29/19, the laboratory failed to ensure all testing personnel participated in the laboratory PT events. Findings: 1. Review of laboratory procedure "Proficiency Testing for Kinston Pediatric Associate Branches" revealed "Every person who performs the CBC in all offices is required to run at least one sample during the year." 2. Review of 2017, 2018 and 2019 MLE PT records revealed only 1 of 3 TP, TP #1, participated in the following MLE PT events: a. 2017 MLE-M3 b. 2018 MLE-M1 c. 2018 MLE-M2 d. 2018 MLE-M3 e. 2019 MLE-M1 f. 2019 MLE- M2 3. Interview with TP #1 at approximately 11:00 a.m. confirmed she was the only testing personnel that participated in the last 6 MLE PT events. 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 --

πŸ”’ Unlock Deficiency Summary

Get full access to the detailed deficiency summary for this facility

One-time payment β€’ Lifetime access