Centracare Paynesville

CLIA Laboratory Citation Details

3
Total Citations
6
Total Deficiencyies
6
Unique D-Tags
CMS Certification Number 24D0406017
Address 200 1st Street W, Paynesville, MN, 56265
City Paynesville
State MN
Zip Code56265
Phone(320) 243-3767

Citation History (3 surveys)

Survey - September 19, 2024

Survey Type: Standard

Survey Event ID: 5TAS11

Deficiency Tags: D5421 D5407 D5417

Summary:

Summary Statement of Deficiencies D5407 PROCEDURE MANUAL CFR(s): 493.1251(d) Procedures and changes in procedures must be approved, signed, and dated by the current laboratory director before use. This STANDARD is not met as evidenced by: . Based on observation, document review, and interview with laboratory personnel, the laboratory director failed to approve all procedures in use by the laboratory in 2023. Findings are as follows: 1. The laboratory performed Urinalysis testing as confirmed by Testing Personnel 3 during a tour of the laboratory at 11:05 a.m. on 09 /11/24. 2. An Arkray Aution Eleven analyzer was observed as present and available for use during the tour. The laboratory performed automated urinalysis testing using this analyzer beginning on 07/31/23. 3. PV documentation for urinalysis testing on the Aution Eleven analyzer included an accuracy verification via method comparison. The accuracy verification was approved by the General Supervisor on 07/25/23. Precision, reportable range, and reference range PV documentation was not found. See D5421 4. Laboratory director approval of the Aution Eleven PV was not found. The laboratory was unable to provide this documentation upon request.. 5. In an interview at 10:55 a.m. on 09/12/24, the Technical Consultant confirmed the above finding. . D5417 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(d) Reagents, solutions, culture media, control materials, calibration materials, and other supplies must not be used when they have exceeded their expiration date, have deteriorated, or are of substandard quality. 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 observation, document review, and interview with laboratory personnel, the laboratory failed to ensure two of two benchtop Bacteriology reagents were not used for patient testing after the expiration date had been exceeded in 2024. Findings are as follows: 1. The laboratory performed Bacteriology Beta Lactamase and microbial identification and antibiotic susceptibility testing as confirmed by Testing Personnel 3 (TP3) during a tour of the laboratory beginning at 11:05 a.m. on 09/11/24. 2. The following testing materials were observed as present and available for use during the tour of the laboratory: 0.45% Sodium Chloride Inhalation Solution (saline) Lot ZI-2208122 expiration date 08/01/24 Sterile Water for Irrigation Lot number 32- 610-48-02 expiration date 08/01/24 Cefinase Beta Lactamase detection discs Lot number 4004767 Expiration date 01/03/25 Vitek 2 microbial identification and antibiotic susceptibility analyzer 3. The laboratory used expired sterile water for two Beta Lactamase tests on patient specimens in the time period of 08/01/24 through 09 /11/24 as indicated by TP3 during the tour and confirmed in laboratory records. 4. The laboratory used expired saline for 127 microbial identification and antibiotic susceptibility tests on patient specimens using the Vitek 2 analyzer in the time period of 08/01/24 through 09/11/24 as indicated by TP1 at 11:20 a.m. on date of survey. This information was obtained from the laboratory information system. 5. In an interview at 11:10 a.m. on 09/11/24, TP3 confirmed the sterile water and sterile saline expiration dates had been exceeded. . D5421 ESTABLISHMENT AND VERIFICATION OF PERFORMANCE CFR(s): 493.1253(b)(1) Each laboratory that introduces an unmodified, FDA-cleared or approved test system must do the following before reporting patient test results: (1)(i) Demonstrate that it can obtain performance specifications comparable to those established by the manufacturer for the following performance characteristics: (1)(i)(A) Accuracy. (1)(i) (B) Precision. (1)(i)(C) Reportable range of test results for the test system. (1)(ii) Verify that the manufacturer's reference intervals (normal values) are appropriate for the laboratory's patient population. This STANDARD is not met as evidenced by: . Based on observation, document review, and interview with laboratory personnel, the laboratory failed to complete required performance verification (PV) activities for one of one new analyzers implemented by the laboratory in 2023. Findings are as follows: 1. The laboratory performed Urinalysis testing as confirmed by Testing Personnel 3 during a tour of the laboratory at 11:05 a.m. on 09/11/24. 2. An Arkray Aution Eleven analyzer was observed as present and available for use during the tour. The laboratory performed an automated urinalysis test panel using this analyzer which included the following ten analytes: Glucose, Protein, Bilirubin, pH, Blood, Urobilinogen, Ketone, Nitrate, Leukocyte, Specific Gravity. 3. PV documentation for urinalysis testing on the Aution Eleven analyzer included an accuracy verification via method comparison. Precision, reportable range, and reference range PV documentation was not found. Laboratory director approval of the PV was not found. See D5407 The laboratory was unable to provide the missing documentation upon request. 4. In an interview at 10:55 a.m. on 09/12/24, the Technical Consultant confirmed the above finding. 5. In an email received at 10:42 a.m. on 09/19/24, the GS indicated urinalysis testing on the Aution Eleven analyzer was implemented on 07 /31/24 and the laboratory performed 2586 urinalysis tests in the time period of 07/31 /23 through 09/12/24. . -- 2 of 2 --

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Survey - January 5, 2021

Survey Type: Standard

Survey Event ID: IWX211

Deficiency Tags: D5211

Summary:

Summary Statement of Deficiencies 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 document review and interview with laboratory personnel, the laboratory failed to investigate an unacceptable Chemistry proficiency testing (PT) result for 1 analyte in 2019. Findings are as follows: 1. The laboratory performed Chemistry testing as confirmed by the Technical Supervisor (TS) during the entrance interview at 8:05 a.m. on 01/05/21. 2. The laboratory performed PT using the Wisconsin State Laboratory of Hygiene (WSLH) and American Proficiency Institute programs. 3. The laboratory received an unacceptable pH PT result in 1 of the 21 scheduled PT events completed in 2019. See below. WSLH 2019 Blood Gas 3rd event Sample Test Lab result WSLH range BG-11 pH 7.125 7.168-7.248 4. Investigation of unacceptable PT results was required as established in the Proficiency Testing Policy located in the laboratory's electronic document management software PolicyStat. 5. An investigation of the unacceptable PT result was not found during review of laboratory records. The laboratory was unable to provide investigation documentation upon request. 6. In an interview at 11:00 a.m. on 01/05/21, the TS confirmed the above finding. 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 - October 5, 2018

Survey Type: Standard

Survey Event ID: SBYQ11

Deficiency Tags: D5775 D5807

Summary:

Summary Statement of Deficiencies D5775 COMPARISON OF TEST RESULTS CFR(s): 493.1281(a)(c) (a) If a laboratory performs the same test using different methodologies or instruments, or performs the same test at multiple testing sites, the laboratory must have a system that twice a year evaluates and defines the relationship between test results using the different methodologies, instruments, or testing sites. (c) The laboratory must document all test result comparison activities. This STANDARD is not met as evidenced by: . Based on observation, document review and interview with laboratory personnel, the laboratory failed to establish a system to evaluate and define the relationship between test results obtained from different analyzers or methodologies at least twice annually. Findings are as follows: 1. The laboratory performed Chemistry testing as confirmed by Technical Consultant 1 (TC1) during a tour of the laboratory on 10/04/18 at 8:05 a. m. 2. An Abbott Architect Chemistry Analyzer and Alere Triage Meter were observed as present and available for use during the tour of the laboratory. 3. TC1 indicated that the Abbott Architect Chemistry Analyzer was the primary testing method for Troponin, and that the Alere Triage Meter was available as a back-up testing method. 4. The laboratory's procedure manuals did not include a system to define and evaluate the relationship between test results obtained from different test methodologies or analyzers at least twice annually. Documentation of such an evaluation for Troponin was not found during review of laboratory records. 5. In an interview on 10/04/18 at 12:15 p.m., TC1 confirmed the above findings. . D5807 TEST REPORT CFR(s): 493.1291(d) Pertinent "reference intervals" or "normal" values, as determined by the laboratory performing the tests, must be available to the authorized person who ordered the tests 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 -- and, if applicable, the individual responsible for using the test results. This STANDARD is not met as evidenced by: . Based on observation, document review and interview with laboratory personnel, the laboratory failed to ensure reference intervals were consistent between Chemistry & Hematology procedures, and patient final test reports. Findings are as follows: A. Chemistry 1. The laboratory performed Chemistry testing as confirmed by Technical Consultant 1 (TC1) during a tour of the laboratory on 10/04/18 at 8:05 a.m. 2. An Abbott i-Stat chemistry analyzer was observed as present and available for use during the tour. 3. The reference intervals listed in the i-Stat Test System procedure, located in the on-line procedure manual, were not consistent with those included on a patient test report (Female - 63 years, Date performed = 5/3/18) reviewed on date of survey. See below. Analyte Procedure Report pO2* 75 - 85 80 - 105 HCO3* 20 - 26 22 - 26 Total CO2 21 - 27 24 - 30 Base Excess 0 - 2 0 - 3 4. In an interview on 10/4/18 at 3:10 p.m., TC1 confirmed the above findings. * pO2 = Partial Pressure of Oxygen * HCO3 = Bicarbonate B. Hematology 1. The laboratory performed Hematology testing as confirmed by Technical Consultant 1 (TC1) during a tour of the laboratory on 10/04 /18 at 8:05 a.m. 2. A Nikon Eclipse SO1 microscope was observed as present and available for use during the tour. 3. The reference values intervals listed in the Hematology Normal Values table, located in the on-line procedure manual, were not consistent with those included on a patient test report (Female - 76 years, Date performed = 2/23/17) reviewed on date of survey. See below. Analyte Table Report % Neutrophils 48 - 76 43 - 80 (Segs*) 0 - 6 (Bands*) % Lymphocytes 20 - 48 16 - 49 Absolute Neutrophils 1.7 - 8.4 1.8 - 9.2 Absolute Lymphocytes 0.8 - 5.3 1.2 - 3.9 4. In an interview on 10/4/18 at 3:10 p.m., TC1 confirmed the above findings. * Segs = Segmented Neutrophils *Bands = Non-segmented Neutrophils . -- 2 of 2 --

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