Carafem North Shore

CLIA Laboratory Citation Details

3
Total Citations
9
Total Deficiencyies
9
Unique D-Tags
CMS Certification Number 14D2155189
Address 4711 Golf Rd - Ste 920, Skokie, IL, 60076
City Skokie
State IL
Zip Code60076
Phone(855) 729-2272

Citation History (3 surveys)

Survey - September 12, 2024

Survey Type: Standard

Survey Event ID: V74E11

Deficiency Tags: D2010

Summary:

Summary Statement of Deficiencies D2010 TESTING OF PROFICIENCY TESTING SAMPLES CFR(s): 493.801(b)(2) The laboratory must test samples the same number of times that it routinely tests patient samples. This STANDARD is not met as evidenced by: Based on review of laboratory procedures, American Proficiency Institute (API) proficiency testing (PT) records, and interview with testing personnel (TP) #2; the laboratory failed to test PT samples the same number of times as patient samples for three of six PT events between 2022 and 2024 for the specialty of Immunohematology. Findings Include: 1. Review of the laboratory procedure, "Chapter 1: Quality Assessment Plan for Laboratory Testing", stated "We will treat the proficiency testing specimens exactly as we treat patient samples, From accessioning through reporting. We will repeat the tests only if we would repeat patient samples under the same conditions (for example, if the result is a critical value)." 2. Review of API attestation statements found documentation of the PT samples being performed in duplicate by different testing personnel (TP#2, TP#3 and one TP no longer employed (NLE)) on three of six PT records reviewed. A. API 2024 first event had documentation that TP #1 and TP #2 tested samples: RH-01, RH-02, RH-03, RH-04, and RH-05 on 04-15-24. B. API 2023 third event had documentation that TP #1 and TP NLE tested samples: RH-11, RH-12, RH-13, RH-14, and RH-15 on 11-30-23. C. API 2023 second event had documentation that TP #1, TP #2, and TP NLE tested samples: RH-06, RH-07, RH-08, RH-09, and RH-10 on 09-15-23. 3. Interview with TP#2 on survey date 09-12-2024, at 10:04 am, confirmed the PT procedure was not followed and multiple TP had analyzed the PT samples prior to the submission deadline for the PT events identified. 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 - April 7, 2021

Survey Type: Standard

Survey Event ID: S7Y811

Deficiency Tags: D3035 D3037 D5209

Summary:

Summary Statement of Deficiencies D3035 RETENTION REQUIREMENTS CFR(s): 493.1105(a)(3)(ii) In addition, the laboratory must retain immunohematology records, blood and blood product records, and transfusion records as specified in 21 CFR 606.160(b)(3)(ii), (b) (3)(iv), (b)(3)(v), and (d). This STANDARD is not met as evidenced by: Based on record review, lack of documentation, and an interview with the testing personnel (TP2), the laboratory failed to retain the quality control (QC) records for the Immunohematology testing performed, for at least 2 years. Findings include: 1. The laboratory's procedures manual and control logs from the months of August and December of 2019, March and September of 2020, and February of 2021 were reviewed. 2. The laboratory used ELDON RhD visual agglutination test card for Rhesus (RH) factor D antigen testing. 3. The Control logs revealed the quality control (QC) test cards were not retained for the 5 out of 5 months selected for review. 4. Further review showed the laboratory recorded QC results but had never retained the QC test cards. 5. The laboratory failed to include, when establishing it's patients' test card retention policy, to include the retention of its QC test cards as required. 6. On a Recertification survey conducted on 04/07/2021 at 11:45 AM, the TP2 confirmed the above findings. D3037 RETENTION REQUIREMENTS CFR(s): 493.1105(a)(4) Proficiency testing records. Retain all proficiency testing records for at least 2 years. This STANDARD is not met as evidenced by: Based on record review, lack of documentation, and an interview with the testing 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 -- personnel (TP2), the laboratory failed to retain all proficiency testing (PT) records for the Immunohematology testing performed, for at least 2 years. Findings include: 1. The laboratory's procedures manual and American Proficiency Institute (API) PT records for 2019 through 2021 were reviewed. 2. The laboratory participated in the API-PT program for the Rhesus (RH) Factor D Antigen visual agglutination test performed in the laboratory . 3. Review of the API-PT documents revealed the PT sample test cards were not retained for 6 out of 6 PT testing events. 4. Further review showed the laboratory recorded PT results but had never retained the PT test cards. 5. The laboratory failed to include, when establishing it's patients' test card retention policy, to also include the retention of its PT sample test cards as required. 6. On a Recertification survey conducted on 04/07/2021 at 11:45 AM, the TP2 confirmed the above findings. 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, the Laboratory Personnel Report (CMS 209), and an interview with the testing personnel (TP2); the laboratory failed to establish written procedures to include the assessment of individual's test performance who are performing Immunohematology testing, affecting 2 out of 2 TP. Findings: 1. The CMS 209, personnel records, and procedures manual were reviewed. 2. The laboratory failed to have a written competency procedure which included one of the following: *The assessment of test performance through testing previously analyzed specimens, *Through internal blind testing samples or *Through external proficiency testing (PT) samples, to evaluate the TP performing Rhesus (RH) factor D antigen testing. 3. The CMS 209 listed 2 TP (TP1 and TP2) performing Rh factor D testing. 4. The personnel documents for TP1 and TP2 did not include test performance training and evaluation. 5. On a Recertification survey conducted on 04/07/2021 at 11:45 AM, the TP2 confirmed the above findings. -- 2 of 2 --

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Survey - March 19, 2019

Survey Type: Standard

Survey Event ID: ZQHJ11

Deficiency Tags: D3031 D5413 D5800 D5801 D5891

Summary:

Summary Statement of Deficiencies D3031 RETENTION REQUIREMENTS CFR(s): 493.1105(a)(3) Analytic systems records. Retain quality control and patient test records (including instrument printouts, if applicable) and records documenting all analytic systems activities specified in 493.1252 through 493.1289 for at least 2 years. This STANDARD is not met as evidenced by: Based on record review, lack of documentation, and an interview with the technical consultant (TC1), the laboratory failed to retain the patient test records for the Rhesus (RhD) testing performed for at least 2 years for 17 out of 17 patients. Findings include: 1. The laboratory's standard operating procedures (SOP) manual and patient test logs were reviewed. 2. The ELDON RhD card test kits were used for Rhesus factor testing. 3. Review of the patient test logs revealed 17 patients were tested with the above test cards. 4. The laboratory failed to retain the test cards for 17 out of 17 patients. 5. The laboratory SOP failed to require the retention of patients' RhD test cards. 6. TC1 confirmed on 03/19/2019 at 1:00 PM, that the laboratory did not keep the patient test cards. 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. 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 -- This STANDARD is not met as evidenced by: Based on record review, lack of documentation, and an interview with the technical consultant (TC1), the laboratory failed to monitor and document manufacturer's required conditions essential for proper storage of test kits to ensure accurate and reliable test system operations for 17 out of 17 patients. Findings include: 1. The laboratory's standard operating procedures (SOP) manual, manufacturer's package insert, kit and quality control (QC) logs were reviewed. 2. The ELDON RhD card package insert stated the ELDON RhD tests cards must be stored between 5 to 37 degrees Celsius. 3. The kit and QC logs showed no documentation of room temperatures in the location where ELDON RhD cards are stored. 4. The SOP failed to include a policy and procedure for ensuring the storage room for the test cards is monitored. 5. On 03/19/2019 at 1:00 PM, the TC1 confirmed the above findings. D5800 POSTANALYTIC SYSTEMS CFR(s): 493.1290 Each laboratory that performs nonwaived testing must meet the applicable postanalytic systems requirements in 493.1291 unless HHS approves a procedure, specified in Appendix C of the State Operations Manual (CMS Pub. 7) that provides equivalent quality testing. The laboratory must monitor and evaluate the overall quality of the postanalytic systems and correct identified problems as specified in 493. 1299 for each specialty and subspecialty of testing performed. This CONDITION is not met as evidenced by: Based on review of laboratory logs, test records and an interview with the technical consultant (TC1); 1. The laboratory failed to accurately and reliably transcribe test results into the patient electronic medical records (EMR). See D5801. 2. The laboratory failed to establish written quality assurance policies and procedures for the post-analytic phase of the Rhesus (RhD) factor testing performed. See D5891. D5801 TEST REPORT CFR(s): 493.1291(a) The laboratory must have an adequate manual or electronic system(s) in place to ensure test results and other patient-specific data are accurately and reliably sent from the point of data entry (whether interfaced or entered manually) to final report destination, in a timely manner. This includes the following: (a)(1) Results reported from calculated data. (a)(2) Results and patient-specific data electronically reported to network or interfaced systems. (a)(3) Manually transcribed or electronically transmitted results and patient-specific information reported directly or upon receipt from outside referral laboratories, satellite or point-of-care testing locations. This STANDARD is not met as evidenced by: Based on record review and an interview with the technical consultant (TC1), the laboratory failed to accurately and reliably enter test results into the patient electronic medical records (EMR), for 1 (Patient-CX3) out of 8 patients. Findings include: 1. The laboratory's standard operating procedures (SOP) manual, patient electronic records, and patient test logs were reviewed. 2. The review of 8 patients' Rhesus (RhD) test results from the test log showed the following: Patient-CX3's result for RhD factor recorded on the test log was negative(-); Patient-CX3's result for RhD -- 2 of 3 -- factor recorded in the patient's EMR was positive(+). 3. On 03/19/2019 at 1:00 PM, the TC1 confirmed the above findings. D5891 POSTANALYTIC SYSTEMS QUALITY ASSESSMENT CFR(s): 493.1299(a) The laboratory must establish and follow written policies and procedures for an ongoing mechanism to monitor, assess and, when indicated, correct problems identified in the postanalytic systems specified in 493.1291. This STANDARD is not met as evidenced by: Based on record review and an interview with the technical consultant (TC1), the laboratory failed to establish written policies and procedures for an ongoing mechanism to monitor, assess, and when indicated, correct problems identified in transcribing patients' results, for 1 (Patient-CX3) out 8 patients. Findings include: 1. The laboratory's standard operating procedures (SOP) manual, patient electronic records, and patient test logs were reviewed. 2. Review of 8 patients' test results revealed 1 out of 8 patients' test results were transcribed into the electronic medical record (EMR) incorrectly (See D5801). 3. The SOP failed to include a policy and procedure for monitoring and preventing transcription errors when reporting patient results in their EMR. 4. On 03/19/2019 at 1:00 PM, the TC1 confirmed the above findings. -- 3 of 3 --

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