Contemporary Family Medicine

CLIA Laboratory Citation Details

3
Total Citations
27
Total Deficiencyies
12
Unique D-Tags
CMS Certification Number 45D0921162
Address 200 East Boothe Street Suite 100, Cleveland, TX, 77327
City Cleveland
State TX
Zip Code77327
Phone281 592-2888
Lab DirectorGEORGE STOKES

Citation History (3 surveys)

Survey - August 12, 2024

Survey Type: Standard

Survey Event ID: JB9C11

Deficiency Tags: D0000 D2007 D0000 D2007 D5403 D5403

Summary:

Summary Statement of Deficiencies D0000 An announced survey of the laboratory was conducted on08/12/2024. The laboratory was found in compliance with applicable CLIA regulations (42 CFR Part 493, Requirements for Laboratories) for the specialties/subspecialties for which it was surveyed. STANDARD LEVEL DEFICIENCIES were cited. D2007 TESTING OF PROFICIENCY TESTING SAMPLES CFR(s): 493.801(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's submitted form "Listing of Laboratory Personnel", proficiency testing (PT) records, policies/procedures and staff interview, the laboratory failed to incorporate PT into regular patient workload for 2 of 3 personnel who routinely performed complete blood count (CBC) testing in the laboratory in 2023, testing person (TP) number 2 and TP number 4. Findings included: 1. Review of laboratory's submitted form "Listing of Laboratory Personnel" revealed there were 3 testing personnel in 2023 (TP1, TP2 and TP4) that routinely performed CBC testing. 2. Review of laboratory's American Proficiency Institute PT records from 2023 revealed all testing events were performed by the same personnel, TP number 1. There was no documentation of PT performance with routine patient testing for TP number 2 or TP number 4 (as indicated on submitted form "Listing of Laboratory Personnel"). 3. Review of laboratory's policies/procedures revealed there were no protocols in place for ensuring that PT is incorporated into regular patient workload with rotation among laboratory's testing personnel. 4. In an interview on 08/12/2024 at 1010 hours in the laboratory, TP number 1 (as indicated on submitted Form CMS 209) confirmed the findings. 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 -- 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 - July 27, 2021

Survey Type: Special

Survey Event ID: V9IR11

Deficiency Tags: D3000

Summary:

Summary Statement of Deficiencies D0000 Noted deficiencies and plans of correction were discussed with the laboratory representative(s) at the exit conference. The facility representative(s) were given an opportunity to provide evidence of compliance with the noted deficiencies, and no such evidence was provided prior to survey exit. The facility was found to be in compliance with applicable Conditions of Participation in the CLIA program, and recertification is recommended. Note: The CMS-2567 (Statement of Deficiencies) is an official, legal document. All information must remain unchanged except for entering the

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Survey - July 27, 2021

Survey Type: Standard

Survey Event ID: 1BYC11

Deficiency Tags: D0000 D5401 D5403 D5411 D5413 D5421 D5445 D5447 D5469 D5791 D0000 D5401 D5403 D5411 D5413 D5421 D5445 D5447 D5469 D5791

Summary:

Summary Statement of Deficiencies D0000 Noted deficiencies and plans of correction were discussed with the laboratory representative(s) at the exit conference. The facility representative(s) were given an opportunity to provide evidence of compliance with the noted deficiencies, and no such evidence was provided prior to survey exit. The facility was found to be in compliance with applicable Conditions of Participation in the CLIA program, and recertification is recommended. Note: The CMS-2567 (Statement of Deficiencies) is an official, legal document. All information must remain unchanged except for entering the

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