Centracare - Sauk Centre

CLIA Laboratory Citation Details

3
Total Citations
14
Total Deficiencyies
12
Unique D-Tags
CMS Certification Number 24D0406054
Address 425 Elm Street North, Sauk Centre, MN, 56378
City Sauk Centre
State MN
Zip Code56378
Phone(320) 352-6591

Citation History (3 surveys)

Survey - February 16, 2023

Survey Type: Standard

Survey Event ID: LE7I11

Deficiency Tags: D5791 D5433

Summary:

Summary Statement of Deficiencies D5433 MAINTENANCE AND FUNCTION CHECKS CFR(s): 493.1254(b)(1) For equipment, instruments, or test systems developed in-house, commercially available and modified by the laboratory, or maintenance and function check protocols are not provided by the manufacturer, the laboratory must establish a maintenance protocol that ensures equipment, instrument, and test system performance that is necessary for accurate and reliable test results and test result reporting. The laboratory must perform and document the maintenance activities specified in paragraph (b)(1)(i) of this section. This STANDARD is not met as evidenced by: . Based on observation, document review, and interview with laboratory personnel, the laboratory failed to perform and document maintenance activities for Immunohematology equipment as required in 2022 and 2023. Findings are as follows: 1. The laboratory performed Immunohematology testing as confirmed by the General Supervisor during a tour of the laboratory at 8:05 a.m. on 02/16/23. 2. The LISS dispenser was observed in the Immunohematology area of the laboratory as present and available for use during the tour. 3. LISS dispenser weekly cleaning was required as established in the LISS Dispenser Cleaning and Calibration procedure found in the laboratory's electronic procedure program PolicyStat. 4. The LISS Dispenser Cleaning and Calibration Log indicated weekly cleaning was performed consistently from 11/11 /21 through 07/21/22 and cleaning after 07/21/22 was performed intermittently. See below Date Date Weeks elapsed 07/21/22 10/15/22 12.4 10/15/22 01/06/23 12 01/06 /23 01/23/23 2.6 01/23/23 02/02/23 1.6 02/02/23 N/A 2.1* *Date of survey, 02/16/23, used for calculation 5. In an interview at 3:50 p.m. on 02/16/23, Testing Personnel 1 confirmed the above finding and indicated the LISS dispenser weekly cleaning had been performed but was not documented. . D5791 ANALYTIC SYSTEMS QUALITY ASSESSMENT 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 -- CFR(s): 493.1289(a)(c) (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 analytic systems specified in 493.1251 through 493.1283. (c) The laboratory must document all analytic systems assessment activities. This STANDARD is not met as evidenced by: . Based on observation, document review, and interview with laboratory personnel, the laboratory failed to identify and correct unacceptable comparison results for one of eight Chemistry analytes in 2022 and one of eight Chemistry analytes in 2023. Findings are as follows: 1. The laboratory performed Chemistry testing as confirmed by the The General Supervisor (GS) during a tour of the laboratory at 8:05 a.m. on 2 /16/23. 2. The laboratory performed an eight analyte Basic Metabolic Panel (BMP) Chemistry test using the Abbott Architect Plus ci4100 analyzer as the primary method and the Abbott i-STAT CHEM8+ cartridge as the back up method. 3. Twice annual comparison of BMP results obtained from the Architect Plus ci4100 and the i-STAT analyzers was required as established on the Quality Assurance Monitor form located in the Lab Quality Assurance Plan manual. The result comparison acceptability criteria was 10% or +/- 4 units as indicated on the Method Comparison form. 4. One of eight analytes did not meet the acceptability criteria during comparisons completed on 11/22/22 and on 02/15/23. See below Date Analyte Values Difference 11/22/22 BUN 23,28 19.6% , 5 units 02/15/23 CO2 25,30 18.18%, 5 units 5. The laboratory did not identify the unacceptable comparison results and failed to perform investigation or correction of the issue. 6. In an interview at 12:45 p.m. on 02/16/23, the GS confirmed the above finding. . -- 2 of 2 --

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Survey - June 3, 2021

Survey Type: Standard

Survey Event ID: 9I9X11

Deficiency Tags: D5211 D5215 D5807

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 General Supervisor (GS) during a tour of the laboratory at 10:05 a.m., on 06/2/21. 2. The laboratory performed PT using the American Proficiency Institute (API) program. 3. The laboratory received an unacceptable partial pressure of oxygen (pO2) PT result for 1 of 5 pO2 PT challenges completed in 2019. See below. API 2019 Chemistry / Core 3rd event Sample Test IB-15 pO2 4. Investigation of unacceptable PT results was required as established in the Proficiency Testing Policy located in the on-line policy and procedure manual. 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 11:45 a.m., on 06/2/21, the GS confirmed the above finding. . D5215 EVALUATION OF PROFICIENCY TESTING PERFORMANCE CFR(s): 493.1236(b)(2) The laboratory must verify the accuracy of any analyte, specialty or subspecialty assigned a proficiency testing score that does not reflect laboratory test performance (that is, when the proficiency testing program does not obtain the agreement required for scoring as specified in subpart I of this part, or the laboratory receives a zero score for nonparticipation, or late return or results). 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 document review and interview with laboratory personnel, the laboratory failed to verify the accuracy of one 2019 proficiency testing (PT) result when the PT program did not obtain the agreement required for scoring. Findings are as follows: 1. The laboratory performed Microbiology testing as confirmed by the General Supervisor (GS) during a tour of the laboratory at 10:05 a.m., on 6/2/21. 2. The laboratory performed PT using the American Proficiency Institute (API) program. 3. One urine culture minimum inhibitory concentration (MIC), for a total of 16 antibiotics, from the third 2019 Microbiology PT event was not graded by API due to lack of consensus. See below. Sample ID Analyte UR-11 Urine culture MIC 4. Investigation of non-graded PT results was required as established in the Proficiency Testing Policy located in the on-line policy and procedure manual. 5. The API report referred the laboratory to the expected result data summary for evaluation of the non- graded test result. The data summary for the above analyte was not present in laboratory records. Evaluation of the non-graded result was not found in laboratory records. 6. In an interview at 11:45 a.m., on 6/2/21, the GS confirmed the above finding. . 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 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 a reference interval was consistent between a Chemistry procedure and a patient test report. Findings are as follows: 1. The laboratory performed Chemistry testing as confirmed by the General Supervisor (GS) during a tour of the laboratory at 10:05 a.m., on 06/2/21. 2. An Abbott i-STAT chemistry analyzer was observed as present and available for use during the tour. 3. A reference interval listed in the Blood Gas & CHEM 8+ i-STAT Test System procedure, located in the on-line policy and procedure manual, was not consistent with that included on a patient test report reviewed on date of survey, as indicated below. Patient - adult female, aged 46 yrs, tested on 5/26/21 Test: Ionized Calcium Procedure 1.12 - 1.32 mmol/L Report 0.95 - 1.31 mmol/L 4. In an interview at 2:45 p. m., on 6/2/21, the GS confirmed the above finding. . -- 2 of 2 --

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Survey - January 14, 2019

Survey Type: Federal Monitoring Survey, Standard

Survey Event ID: 1I6M12

Deficiency Tags: D3031 D5471 D5807 D0000 D5215 D5553 D6086 D6090 D6120

Summary:

Summary Statement of Deficiencies D0000 An off-site revisit survey was conducted on 5/30/2017 and on 3/15/2018 for all previous deficiencies cited on 4/5/2017. All deficiencies have been corrected and no new noncompliance was found. CentraCare Health Sauk Centre laboratory is in substantial compliance with the regulations of the Clinical Laboratory Improvement Amendments of 1988 (42 C.F.R. part 493, effective April 24, 2003). 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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