Brentwood Pediatric & Adolescent Associates Pc

CLIA Laboratory Citation Details

3
Total Citations
26
Total Deficiencyies
12
Unique D-Tags
CMS Certification Number 33D1061157
Address 1464 Fifth Avenue, Bay Shore, NY, 11706
City Bay Shore
State NY
Zip Code11706
Phone631 231-5070
Lab DirectorMICHAEL LEE

Citation History (3 surveys)

Survey - January 23, 2025

Survey Type: Standard

Survey Event ID: 38SE11

Deficiency Tags: D2007 D2007 D2009 D2009 D5211 D5211 D5413 D5413 D5439 D6000 D5439 D6000

Summary:

Summary Statement of Deficiencies D2007 TESTING OF PROFICIENCY TESTING SAMPLES CFR(s): 493.801(b)(1) (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 of laboratory testing logs, Wisconsin State Laboratory of Hygiene (WSLH) Proficiency Testing (PT) records, as well as interview with the Laboratory Director (LD), the laboratory failed to test PT samples by testing personnel (TP) who routinely perform patient testing. FINDINGS: 1. Laboratory testing logs documented ten TP who routinely perform patient testing yet WSLH PT records from 2023 through the survey date did not document rotation of PT among the respective ten TP. 2. The LD confirmed the findings on January 23, 2025, at approximately 11:30 A.M. D2009 TESTING OF PROFICIENCY TESTING SAMPLES CFR(s): 493.801(b)(1) (b)(1) The individual testing or examining the samples and the laboratory director must attest to the routine integration of the samples into the patient workload using the laboratory's routine methods. This STANDARD is not met as evidenced by: Based on review of WSLH PT records as well as interview with the LD, the laboratory failed to retain documented attestation to routine integration of the samples into the patient workload using the laboratory's routine methods. FINDINGS: 1. There 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 -- was no documentation of WSLH PT signed attestation for calendar year 2023 through survey date. 2. The LD confirmed the findings on January 23, 2025, at approximately 11:30 A.M. D5211 EVALUATION OF PROFICIENCY TESTING PERFORMANCE CFR(s): 493.1236(a) The laboratory must review and evaluate the results obtained on proficiency testing performed as specified in subpart H of this part. This STANDARD is not met as evidenced by: Based on review of the WSLH PT summary reports as well as interview with the LD, the LD failed to document review and date of review of the results obtained on proficiency testing performed. FINDINGS: 1. There was no documentation of WSLH PT summary report LD review and date of review for calendar year 2023 through survey date. 2. The LD confirmed the findings on January 23, 2025, at approximately 11:30 A.M. D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(b) (b) The laboratory must define criteria for those conditions that are essential for proper storage of reagents and specimens, accurate and reliable test system operation, and test result reporting. The criteria must be consistent with the manufacturer's instructions, if provided. These conditions must be monitored and documented and, if applicable, include the following: (b)(1) Water quality. (b)(2) Temperature. (b)(3) Humidity. (b)(4) Protection of equipment and instruments from fluctuations and interruptions in electrical current that adversely affect patient test results and test reports. This STANDARD is not met as evidenced by: Based on lack of laboratory humidity records, review of standard operating procedures (SOPs), patient specimen analyzer manufacturer's specifications, as well as interview with the LD, the laboratory failed to monitor and document humidity in the area where on-site laboratory testing was performed. FINDINGS: 1. The patient specimen Horiba ABX Micros ABX 60 analyzer manufacturer's specifications indicated acceptable humidity range of 20% - 80%. 2. There was no monitoring and documentation of humidity in the area where patient testing was performed from January 2024 through survey date. 3. The current, approved SOPs did not include instructions for performing such activity. 4. The LD confirmed the findings on January 23, 2025, at approximately 11:00 A.M. This is a repeat deficiency from on- site survey performed December 12, 2023. 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 -- 2 of 3 -- 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 review of analyzer calibration records, SOPs, as well as interview with the LD, the laboratory failed to perform and document patient specimen processing analyzer calibration verification. FINDINGS: 1. Horiba ABX Micros 60 analyzer calibration documentation was performed once in 2024. 2. This is contrary to instructions included in the current, approved SOPs which require twice per year analyzer calibration performance. 3. The LD confirmed the findings on January 23, 2025, at approximately 11:00 A.M. D6000 MODERATE COMPLEXITY LABORATORY DIRECTOR CFR(s): 493.1403 The laboratory must have a director who meets the qualification requirements of 493. 1405 of this subpart and provides overall management and direction in accordance with 493.1407 of this subpart. This CONDITION is not met as evidenced by: Based on review of WSLH PT summary reports, current, approved SOPs, patient specimen analyzer manufacturer's specifications, lack of humidity records, as well as interview with the LD, the LD failed to provide overall management and direction of the laboratory services. Refer to D2007, D2009, D50211, D5413, and D5439. -- 3 of 3 --

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Survey - December 12, 2022

Survey Type: Standard

Survey Event ID: CNN111

Deficiency Tags: D5221 D5221 D5413 D5413 D5469 D5469

Summary:

Summary Statement of Deficiencies D5221 EVALUATION OF PROFICIENCY TESTING PERFORMANCE CFR(s): 493.1236(d) All proficiency testing evaluation and verification activities must be documented. This STANDARD is not met as evidenced by: Based on the review of laboratory's American Academy of Family Physicians Proficiency Testing (AAFP PT) summary report of second event of year 2022, the laboratory failed to document evaluation and verification activities Findings 1. AAFP PT Second event: WBC 80%, Lymph 80%, Granulocyte 80%, RBC 60%, HGB 60%, HCT 60%, PLT 80%. 2. Confirmed in an interview with laboratory director on 12/12 /2023 about 12:30pm. D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(b) The laboratory must define criteria for those conditions that are essential for proper storage of reagents and specimens, accurate and reliable test system operation, and test result reporting. The criteria must be consistent with the manufacturer's instructions, if provided. These conditions must be monitored and documented and, if applicable, include the following: (1) Water quality. (2) Temperature. (3) Humidity. (4) Protection of equipment and instruments from fluctuations and interruptions in electrical current that adversely affect patient test results and test reports. This STANDARD is not met as evidenced by: Based on the lack of humidity log, the laboratory failed to monitor humidity since implementation August 2019 through survey date as required by Horiba Micros ABX 60. Finding: 1. Horiba Micros 60: Humidity 20-80% 2. Confirmed on an interview with practice manager on 12/12/2022 about 12pm 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 -- D5469 CONTROL PROCEDURES CFR(s): 493.1256(d)(10)(g) Unless CMS Approves a procedure, specified in Appendix C of the State Operations Manual (CMS Pub. 7), that provides equivalent quality testing, the laboratory must-- Establish or verify the criteria for acceptability of all control materials. (i) When control materials providing quantitative results are used, statistical parameters (for example, mean and standard deviation) for each batch and lot number of control materials must be defined and available. (ii) The laboratory may use the stated value of a commercially assayed control material provided the stated value is for the methodology and instrumentation employed by the laboratory and is verified by the laboratory. (iii) Statistical parameters for unassayed control materials must be established over time by the laboratory through concurrent testing of control materials having previously determined statistical parameters. (g) The laboratory must document all control procedures performed. This STANDARD is not met as evidenced by: Based on review of the laboratory's Quality Control (QC) records, the laboratory failed to perform a verification of current lot number to new lot number of the hematology analyzer Horiba Micros ABX 60. Findings: 1. The new QC lot to lot validation documentations of hematology analyzer were not available upon request during the survey since the hematology analyzer implementation date to survey date. 2. The laboratory director confirmed during interview on 12/12/2022 about 12pm. -- 2 of 2 --

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Survey - October 21, 2019

Survey Type: Standard

Survey Event ID: CHZF11

Deficiency Tags: D2000 D2000 D6015 D6015 D6063 D6065 D6063 D6065

Summary:

Summary Statement of Deficiencies D2000 ENROLLMENT AND TESTING OF SAMPLES CFR(s): 493.801 Each laboratory must enroll in a proficiency testing (PT) program that meets the criteria in subpart I of this part and is approved by HHS. The laboratory must enroll in an approved program or programs for each of the specialties and subspecialties for which it seeks certification. The laboratory must test the samples in the same manner as patients' specimens. For laboratories subject to 42 CFR part 493 published on March 14, 1990 (55 FR 9538) prior to September 1, 1992, the rules of this subpart are effective on September 1, 1992. For all other laboratories, the rules of this subpart are effective January 1, 1994. This CONDITION is not met as evidenced by: Based on lack of proficiency testing (PT) records and confirmed in an interview with the laboratory director, the laboratory failed to enroll in an approved PT program for hematology testing when patient testing was initiated in August 2019. FINDINGS: The laboratory director confirmed on October 21, 2019 at approximately 11:00 AM that the laboratory initiated hematology patient testing in August 2019 but did not enroll in a PT program. D6015 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1407(e)(4) 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) Ensure that the laboratory is enrolled in an HHS approved proficiency testing program for the testing performed. 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 -- This STANDARD is not met as evidenced by: Based on lack of PT records, the laboratory director failed to ensure that the laboratory is enrolled in an approved PT program for hematology for the second and the third events 2019. FINDINGS: The the laboratory director, confirmed on 10/21 /2019 at 11:30 AM that the laboratory initiated hematology testing in August 2019 but did not enroll in PT for this specialty for the second and the third events in 2019. Refer to D2000. D6063 LABORATORY TESTING PERSONNEL CFR(s): 493.1421 The laboratory must have a sufficient number of individuals who meet the qualification requirements of 493.1423, to perform the functions specified in 493. 1425 for the volume and complexity of tests performed. This CONDITION is not met as evidenced by: Based on a surveyor review of personnel records and confirmed in an interview with the laboratory director, the laboratory director failed to ensure that one of eight testing personnel performing moderate complexity testing met the minimum educational requirements of a high school diploma and/or had foreign education diploma evaluated prior to performing patient testing. Refer to D6065 D6065 TESTING PERSONNEL QUALIFICATIONS CFR(s): 493.1423(b)(1)(2)(3)(4)(i) (b) Meet one of the following requirements: (b)(1) Be a doctor of medicine or doctor of osteopathy licensed to practice medicine or osteopathy 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; or (b)(2) Have earned an associate degree in a chemical, physical or biological science or medical laboratory technology from an accredited institution; or (b)(3) Be a high school graduate or equivalent and have successfully completed an official military medical laboratory procedures course of at least 50 weeks duration and have held the military enlisted occupational specialty of Medical Laboratory Specialist (Laboratory Technician); or (b)(4)(i) Have earned a high school diploma or equivalent; and This STANDARD is not met as evidenced by: Based on a surveyor's review of personnel records and confirmed in an interview with the laboratory director at the time of the survey, the laboratory director failed to ensure that one of eight testing personnel performing moderate complexity testing met the minimum educational requirements of a high school diploma and/or had foreign education diploma evaluated prior to performing patient testing. -- 2 of 2 --

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