Bland Clinic-Vmh

CLIA Laboratory Citation Details

3
Total Citations
5
Total Deficiencyies
3
Unique D-Tags
CMS Certification Number 52D0396502
Address 100 Melby St, Westby, WI, 54667
City Westby
State WI
Zip Code54667
Phone(608) 634-3126

Citation History (3 surveys)

Survey - September 3, 2025

Survey Type: Standard

Survey Event ID: FQCX11

Deficiency Tags: D5439 D5439

Summary:

Summary Statement of Deficiencies D5439 CALIBRATION AND CALIBRATION VERIFICATION CFR(s): 493.1255(b) (b)(1) Following the manufacturer's calibration verification instructions; (b)(2) Using the criteria verified or established by the laboratory under 493.1253(b)(3)-- (b)(2)(i) Including the number, type, and concentration of the materials, as well as acceptable limits for calibration verification; and (b)(2)(ii) Including at least a minimal (or zero) value, a mid-point value, and a maximum value near the upper limit of the range to verify the laboratory's reportable range of test results for the test system; and (b)(3) At least once every 6 months and whenever any of the following occur: (b)(3)(i) A complete change of reagents for a procedure is introduced, unless the laboratory can demonstrate that changing reagent lot numbers does not affect the range used to report patient test results, and control values are not adversely affected by reagent lot number changes. (b)(3)(ii) There is major preventive maintenance or replacement of critical parts that may influence test performance. (b)(3)(iii) Control materials reflect an unusual trend or shift, or are outside of the laboratory's acceptable limits, and other means of assessing and correcting unacceptable control values fail to identify and correct the problem. (b)(3)(iv) The laboratory's established schedule for verifying the reportable range for patient test results requires more frequent calibration verification. This STANDARD is not met as evidenced by: Based on laboratory record review and interview with the technical consultant, the laboratory did not meet the requirement of performing calibration verification at least once every six months on their i-STAT chemistry analyzer for one of four calibration verifications required in the past two years. Findings include: 1. Review of laboratory records from the past two years revealed the laboratory conducted calibration verification on its i-STAT chemistry analyzer in December 2023, June 2024, and June 2025. Further review of the laboratory records revealed no evidence that the laboratory performed calibration verification on the i-STAT in December 2024 to meet the six-month requirement. 2. Interview with the technical consultant on 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 -- September 4, 2025, at 2:20 PM, confirmed the laboratory did not perform i-STAT calibration verification in December 2024 to meet the six-month calibration verification requirement. -- 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 - August 2, 2023

Survey Type: Standard

Survey Event ID: JLUC11

Deficiency Tags: D5429

Summary:

Summary Statement of Deficiencies 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 least the frequency specified by the manufacturer. This STANDARD is not met as evidenced by: Based on surveyor review of maintenance logs the KX-21N hematology analyzer and interview with the technical consultant, the laboratory did not document routine daily maintenance for three of twenty-one days in April 2022 and one of twenty-three days in August 2022, did not document routine monthly maintenance for one of six months reviewed between March 2022 and August 2022 and did not document quarterly maintenance for one of four quarters in 2022. Findings include: 1. Review of "KX- 21N Maintenance & Daily Log" showed the following: No documentation of daily maintenance on April 27, 28, and 29, 2022. No documentation of daily maintenance on August 5, 2022. No documentation of monthly maintenance in May 2022. No documentation of quarterly maintenance in June 2022. Further reviewed showed quarterly maintenance in March 2022, September 2022 and December 2022. 2. Interview with the technical consultant on August 2, 2023, at 1:30 PM confirmed the laboratory did not document routine maintenance on the KX-21N hematology analyzer for all daily, monthly and quarterly requirements in 2022. 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

Survey - September 10, 2021

Survey Type: Standard

Survey Event ID: LRBP11

Deficiency Tags: D6019 D6019

Summary:

Summary Statement of Deficiencies D6019 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1407(e)(4)(iv) 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)(4)(iv) Ensure that an approved

πŸ”’ Unlock Deficiency Summary

Get full access to the detailed deficiency summary for this facility

One-time payment β€’ Lifetime access