Dermsurgery Associates-The Woodlands

CLIA Laboratory Citation Details

3
Total Citations
25
Total Deficiencyies
11
Unique D-Tags
CMS Certification Number 45D2116798
Address 17183 I-45 Suite 510, Conroe, TX, 77385
City Conroe
State TX
Zip Code77385
Phone(713) 791-1453

Citation History (3 surveys)

Survey - July 23, 2024

Survey Type: Standard

Survey Event ID: VQUC11

Deficiency Tags: D0000 D0000 D5417 D5417

Summary:

Summary Statement of Deficiencies D0000 An announced survey of the laboratory was conducted on 07/23/2024. 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. 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 on surveyor's observations, review of laboratory's annual test volumes and staff interview, the laboratory failed to ensure 4 of 4 marking dyes used for Mohs procedures were not used after exceeding their expiration date. Findings included: 1. Surveyor's observations on 07/23/2024 at 1310 hours in the laboratory revealed the following marking dyes used for laboratory procedures exceeded their expiration date: Chemtrec Blue Tissue Marking Dye Lot: 148208 Expired: 2024-04-30 Chemtrec Orange Tissue Marking Dye Lot: 148901 Expired: 2024-04-30 Cancer Diagnostics Inc. Blue Tissue Marking Dye Lot: 21133 Expired: 2023-05-31 Cancer Diagnostics Inc. Black Tissue Marking Dye Lot: 21152 Expired: 2023-06-30 2. Review of laboratory's submitted annual test volumes revealed the laboratory performed 1000 Mohs procedures annually. 3. In an interview on 07/23/2024 at 1320 hours in the laboratory, the laboratory's Histotechnologist on duty, after review of the expired products, 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 1 --

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Survey - September 8, 2022

Survey Type: Standard

Survey Event ID: 4HQW11

Deficiency Tags: D0000 D5609 D6128 D5609 D6128

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 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 - August 17, 2018

Survey Type: Standard

Survey Event ID: RL3Y11

Deficiency Tags: D0000 D5217 D5291 D5400 D5413 D6076 D6086 D0000 D5217 D5291 D5400 D5413 D5423 D5423 D6076 D6086

Summary:

Summary Statement of Deficiencies D0000 The laboratory was found out of compliance with the CLIA regulations. The conditions not met were: D5400 - 42 C.F.R. 493.1250 Condition: Analytic systems; D6076 - 42 C.F.R. 493.1441 Condition: Laboratories performing high complexity testing; laboratory director; The facility representative was given an opportunity to provide evidence of compliance with the noted deficiencies, and no such evidence was provided prior to survey exit. D5217 EVALUATION OF PROFICIENCY TESTING PERFORMANCE CFR(s): 493.1236(c)(1) At least twice annually, the laboratory must verify the accuracy of any test or procedure it performs that is not included in subpart I of this part. This STANDARD is not met as evidenced by: A. Based on review of the laboratory records and confirmed in an interview, the laboratory failed to document at least twice annually the accuracy of 1 of 4 tests. (grossing) Findings were: 1. A review of laboratory testing records from 2016 and 2017 revealed no documentation of the laboratory verifying the accuracy for the test grossing for 2016 and 2017. 2. An interview with the Director of Operations on 8/17 /18 at 0940 hours in the laboratory confirmed the above findings. She acknowledged that the laboratory did not perform the twice annual accuracy assessment for 2016 or 2017 for grossing. B. Based on review of the laboratory records and confirmed in an interview, the laboratory failed to include a policy to assess the twice annual accuracy assessments of 4 of 4 tests. (grossing, H/E, Toluidine blue, Mart-1) Findings were: 1. Review of the laboratory policy revised 8/17 revealed no documentation of the acceptance criteria of the physician peer review for the proficiency testing performed for 4 of 4 tests (grossing, H/E, Toluidine blue, Mart-1). 2. A review of the 2016 and 2017 laboratory records revealed the laboratory performed proficiency testing for 3 of 4 tests (H/E, Toluidine blue, and Mart-1) on the following dates with no documention of the assessment of the proficiency testing performed. 9/1/16 10/27/16 5/3/17 9/1/17 Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 4 -- 3. An interview with the Director of Operations on 8/17/18 at 0940 hours confirmed the above findings. key: H/E - Hematoxylin and eosin stain Mart-1: Melan-A (Melanoma Marker) (Cocktail) Ab-3 D5291 GENERAL LABORATORY SYSTEMS QUALITY ASSESSMENT CFR(s): 493.1239(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 general laboratory systems requirements specified at 493.1231 through 493.1236. This STANDARD is not met as evidenced by: Based on review of laboratory policies and records, the laboratory quality assessment failed to identify that the laboratory did not perform and/or assess the twice annual accuracy assessment for all tests performed in the laboratory (refer to D5217A, B). D5400 ANALYTIC SYSTEMS CFR(s): 493.1250 Each laboratory that performs nonwaived testing must meet the applicable analytic systems requirements in 493.1251 through 493.1283, 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 analytic systems and correct identified problems as specified in 493.1289 for each specialty and subspecialty of testing performed. This CONDITION is not met as evidenced by: Based on review of the manufacturer package inserts, patient test logs, a review of the FDA (Federal Drug Administration) website, laboratory's procedure manual and confirmed in interview, the laboratory failed to have a procedure and perform the establishment studies for the MART-1 immunostaining put into use in 2016 (refer to D5423 A, B). 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. This STANDARD is not met as evidenced by: Based on observation, a review of manufacturer's product packaging, and confirmed in interview, the laboratory failed to document the room temperature of the laboratory's storage area. Findings were: 1. During a tour of the laboratory on 8/17/18 at 1020 hours revealed no chart or thermometer for recording room temperature -- 2 of 4 -- available for review at the time of the survey for the laboratory's storage area. 2. A random review of the laboratory supplies in the storage area in the flammable cabinet revealed 1 container of Pro-par Clearant (lot 6290, exp 2020/02) and 1 container of 100% Reagent Alcohol (6900-1, lot 061672, exp 11/19). Review of the manufacturer product packaging of both containers revealed the storage required was "store at room temperature." 3. An interview of the testing person #2 on 8/17/18 at 1030 hours in the laboratory confirmed she was not documenting the room temperature of the laboratory's storage area. D5423 ESTABLISHMENT AND VERIFICATION OF PERFORMANCE CFR(s): 493.1253(b)(2) Each laboratory that modifies an FDA-cleared or approved test system, or introduces a test system not subject to FDA clearance or approval (including methods developed in-house and standardized methods such as text book procedures), or uses a test system in which performance specifications are not provided by the manufacturer must, before reporting patient test results, establish for each test system the performance specifications for the following performance characteristics, as applicable: (2)(i) Accuracy. (2)(ii) Precision. (2)(iii) Analytical sensitivity. (2)(iv) Analytical specificity to include interfering substances. (2)(v) Reportable range of test results for the test system. (2)(vi) Reference intervals (normal values). (2)(vii) Any other performance characteristic required for test performance. This STANDARD is not met as evidenced by: A. Based on review of the manufacturer package inserts, patient test logs, a review of the FDA (Federal Drug Administration) website, laboratory's procedure manual and confirmed in interview the facility failed to have a procedure for conducting establishment studies for the MART-1 immunostaining put into use in 2016. 1. A review of the Thermoscientific MART-1 package insert (REV 102414M) revealed the test was "For Research Use Only". 2. A review of patient test logs from 2016-2018 revealed the facility performed 4 MART-1 immunostaining tests. 4/1/16 17DST20 7 /27/17 17DST188 7/31/17 17DST197 8/21/17 17DST214 3. A review of the FDA (Federal Drug Administration) website revealed the Thermoscientific MART-1 was not an FDA-approved test. Since the test system was not approved by the FDA, the test system performance specifications for analytical sensitivity, analytical specificity, accuracy, precision must be established and verified by the laboratory. 4. A review of laboratory procedures revealed no procedure for conducting method validation studies to establish performance specifications and to validate method performance for the following method characteristics for new test systems, as applicable: accuracy precision (within run, between run, between day) reportable range analytical sensitivity and specificity reference intervals reagent lot variation 5. An interview with the Director of Operations on 08/17/2018 at 0950 hours in the laboratory confirmed the above findings. B. Based on review of the laboratory's patient test logs, a review of the FDA (Federal Drug Administration) website, laboratory records and staff interview, the laboratory failed to document complete establishment studies prior to patient testing for MART-1 immunostaining put into use in 2016. Findings were: 1. A review of the laboratory's patient test logs revealed the laboratory started using the MART-1 immunostaining on 4/1/16. 2. A review of the laboratory's patient test logs from 2016-2018 revealed the laboratory performed MART-1 immunostaining on 4 patients. 4/1/16 17DST20 7/27/17 17DST188 7/31/17 17DST197 8/21/17 17DST214 3. A review of the FDA website revealed the Thermoscientific MART-1 was not an FDA-approved test. Since the test system was not approved by the FDA, the test -- 3 of 4 -- system performance specifications for analytical sensitivity, analytical specificity, accuracy, precision must be established and verified by the laboratory. 3. Review of the laboratory records revealed no documentation of the laboratory establishing the performance specifications for analytical sensitivity, analytical specificity, accuracy, precision studies prior to patient testing for MART-1 immunostaining. 4. An interview with the Director of Operations on 08/17/2018 at 0950 hours in the laboratory confirmed the above findings. Key: Mart-1: Melan-A (Melanoma Marker) (Cocktail) Ab-3 D6076 LABORATORY DIRECTOR CFR(s): 493.1441 The laboratory must have a director who meets the qualification requirements of 493. 1443 of this subpart and provides overall management and direction in accordance with 493.1445 of this subpart. This CONDITION is not met as evidenced by: Based on a review of laboratory records and interview of facility personnel it was revealed that the laboratory director failed to provide overall management and direction of the laboratory services. (refer to D6086) D6086 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1445(e)(3)(ii) The laboratory director must ensure that verification procedures used are adequate to determine the accuracy, precision, and other pertinent performance characteristics of the method. This STANDARD is not met as evidenced by: Based on a review of the laboratory's test system records and interview of facility personnel it was revealed that the laboratory director failed to ensure the laboratory documented complete establishment studies of all test systems before reporting patient test results. (Refer to D5423 A, B) -- 4 of 4 --

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