Clear Creek Dermatology

CLIA Laboratory Citation Details

3
Total Citations
15
Total Deficiencyies
7
Unique D-Tags
CMS Certification Number 45D2258312
Address 904 Ford St, Llano, TX, 78643
City Llano
State TX
Zip Code78643
Phone(830) 953-1700

Citation History (3 surveys)

Survey - July 8, 2026

Survey Type: Standard

Survey Event ID: 6QEH11

Deficiency Tags: D0000 D5417 D5433

Summary:

Summary Statement of Deficiencies D0000 The Clear Creek Dermatology laboratory in Llano was found to be in compliance with the Conditions of the CLIA regulations found at 42 CFR 493.1 through 493.1780, CLIA requirements for laboratories as a result of a recertification survey on 07/07 /2026 and recertification is recommended. Standard level deficiencies were cited. D5417 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(d) (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. This STANDARD is not met as evidenced by: Based on review of the laboratory's policies and procedures, reagent log, observation, reagent check log, patient testing logs, and interview, the laboratory failed to ensure chemicals and stains used in the Hematoxylin and Eosin (H&E) stain used to process Mohs specimens had not exceeded their expiration date by three out of 25 days of testing in 2026. Findings follow. A. 1. Review of the laboratory's policy and procedure titled Quality Control Program, reviewed 06/23/2022, under Test Methods, Equipment, Reagents, Materials and Supplies stated, "Reagents, solutions, culture media, controls, calibration materials and other supplies are not used when they have exceeded their expiration dates, have deteriorated or are of substandard quality." 2. Review of the laboratory's policy and procedure titled Laboratory Procedure Manual Histopathology- Mohs Surgery, on page 32 stated, "4.3.3 Do not use reagent after expiration date unless results are checked and satisfactory (i.e. stains)." The statement "unless results are checked and satisfactory" did not align with the regulatory requirements. B. Review of the Reagent Receipt & Quality Control Record log showed Eosin, Lot # 2415233, expiration 06/14/2026 was opened on 11/20/2025. There were no additional entries for Eosin revealing an elapsed expiration of 23 days. C. Surveyor observed on July 7, 2026 at 1115 hours in the storage room two 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 -- containers of Eosin-y in the flammable cabinet: Mercedes Scientific Eosin-y, Lot #2415233, expiration 06/14/2026. No other Eosin-y was observed. D. Review of the Storage of Flammable Reagents Cabinet Check log for the month of June and the first week of July 2026 showed it was checked on 06/25/2026 but the expired Eosin-y was not documented or discarded. The check was not documented the first week of July 2026. E. Review of the Mohs Specimen Log from 06/15/2026- 07/07/2026 showed three days of Mohs testing with expired Eosin-y with 35 cases reported: M26-255 - M26-289. F. Interview with the Office Manager on July 7, 2026 at 1120 hours confirmed the findings. D5433 MAINTENANCE AND FUNCTION CHECKS CFR(s): 493.1254(b)(1) (b)(1)(i) 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. (b)(1)(ii) Perform and document the maintenance activities specified in paragraph b(1)(i) of this section. This STANDARD is not met as evidenced by: I. Based on review of the manufacturer's instructions, laboratory's policies and procedures, preventive maintenance records, pre-survey documents and email, the laboratory failed to establish and follow a preventive maintenance protocol to ensure the performance of the Accu-Scope microscope for one of two years reviewed in 2024 and 2025. Findings follow. A. Review of the Accu-Scope 3000-LED Series Manual under Care and Maintenance stated, "Accu-Scope microscopes are precision instruments which require periodic preventive maintenance to maintain proper performance and to compensate for normal wear. An annual schedule of preventive maintenance by qualified personnel is highly recommended." B. Review of the laboratory's policy and procedure titled Quality Control Program, revised 06/23/2022, under Equipment Maintenance stated, "The Laboratory Director will ensure that periodic equipment maintenance and function checks are performed as required by the manufacturer or determined by the Laboratory Director. Proper records will be maintained to indicate the tests performed." The policy and procedure did not define the frequency of the preventive maintenance of the microscope. C. Review of the preventive maintenance records for 2024 and 2025 showed no preventive maintenance on the Accu-Scope microscope for 2025. Preventive maintenance records for 2025 were requested on July 7, 2026 at 1140 hours but not provided. D. Review of the CMS Form 116 showed an estimated annual test volume of 449 blocks. E. Email from the Office Manager on July 8, 2026 at 0855 hours confirmed the preventive maintenance for the microscope in 2025 was not done. II. Based on review of the manufacturer's instructions, laboratory's policy and procedure, preventive maintenance records, pre-survey documents and email, the laboratory failed to provide documentation of maintenance performed as defined by their own policy using the Avantik Q12 Cryostat used to cut frozen sections for Mohs testing. Findings follow. A. Review of the Avantik QS12 Cryostat Instruction Manual, 5259000 rev 3, under Cleaning and Care at Preventative Maintenance stated, "It is recommended that preventative maintenance is performed on the instrument at least once a year by a qualified service technician." B. Review of the laboratory's policy and procedure titled Quality Control Program under Equipment Quality control for Cryostats stated, "10) Preventive maintenance and grounding checks are done yearly." C. Review of the preventive maintenance records for 2024 and 2025 showed no preventive maintenance on the Avantik QS12 cryostat in 2025. Preventive maintenance records were -- 2 of 3 -- requested on July 7, 2026 at 1140 hours but not provided. D. Review of the CMS Form 116 showed an estimated annual test volume of 449 blocks. E. Email from the Office Manager on July 8, 2026 at 0855 hours confirmed the preventive maintenance for the cryostat in 2025 was not done. -- 3 of 3 --

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Survey - July 29, 2024

Survey Type: Standard

Survey Event ID: IYDK11

Deficiency Tags: D0000 D5403 D5413 D5413 D0000 D5403 D5781 D5781

Summary:

Summary Statement of Deficiencies D0000 The laboratory was surveyed and found to be in compliance with the Conditions of the CLIA regulations found at 42 CFR 493.1 through 493.1780, and recertification is recommended. Standard level deficiencies were cited. D5403 PROCEDURE MANUAL CFR(s): 493.1251(b) The procedure manual must include the following when applicable to the test procedure: (1) Requirements for patient preparation; specimen collection, labeling, storage, preservation, transportation, processing, and referral; and criteria for specimen acceptability and rejection as described in 493.1242. (2) Microscopic examination, including the detection of inadequately prepared slides. (3) Step-by-step performance of the procedure, including test calculations and interpretation of results. (4) Preparation of slides, solutions, calibrators, controls, reagents, stains, and other materials used in testing. (5) Calibration and calibration verification procedures. (6) The reportable range for test results for the test system as established or verified in 493.1253. (7) Control procedures. (8)

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Survey - January 3, 2023

Survey Type: Standard

Survey Event ID: BFBO11

Deficiency Tags: D5417 D5429 D5417 D5429

Summary:

Summary Statement of Deficiencies 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. This STANDARD is not met as evidenced by: Based upon observations and interview of facility personnel, the laboratory failed to ensure that expired Tissue Marking Dyes were not used in testing the 185 histopathology specimens as recorded on the CMS 116. The findings included: 1. Observations made during the tour of the laboratory found two bottles of expired Cancer Diagnostics, Inc. (CDI) Tissue Marker Dyes (Orange and Violet) in the cabinet. Expiration dates for the two dyes ( as labeled) was 2021-09-30. Testing Person one listed on the CMS 209 Laboratory Personnel report was observed using the expired CDI Tissue Marking Dye to mark tissues at 11:35 AM on January 3, 2023. 2. During interview of the histotechnician conducted January 3, 2023 at 11:37AM confirmed that the expired tissue marking dyes were currently being used in patient testing. 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 upon review of the Operating instructions, maintenance records, and interview 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 -- of facility personal, the laboratory failed to perform and document monthly maintenance procedures for the Tanner Scientific Cryostat TN50 seven of seven months in 2022. The findings included: 1. Review of the Tanner Scientific Cryostat TN50 Operating instructions (2020-03-008.00) found in section 10.3 under the heading RECOMMENDED MAINTENANCE AND SERVICE SCHEDULE: Daily - Remove frozen section waste from the cryostat chamber after every day of usage. Disinfection if necessary. Weekly - Cleaning of the blade holder. Cleaning of the window. Monthly - Check of Temperature sensor in cryochamber. Cleaning of cryostat ventilation. 2. Review of the Maintenance Records for Cryostat for June - December 2022 (7 months) found no documentation of performing the Clean Air Filter maintenance procedure documented. 3. During interview of the histotechnician conducted January 3, 2023 at 11:22 AM, she confirmed she had not performed the monthly maintenance procedures as defined by the manufacturer. -- 2 of 2 --

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