Dermsurgery Associates-Willowbrook

CLIA Laboratory Citation Details

2
Total Citations
11
Total Deficiencyies
5
Unique D-Tags
CMS Certification Number 45D2150709
Address 18220 State Highway 249, Suite 270, Houston, TX, 77070
City Houston
State TX
Zip Code77070
Phone(832) 213-5454

Citation History (2 surveys)

Survey - March 28, 2024

Survey Type: Standard

Survey Event ID: ARRO11

Deficiency Tags: D0000 D0000 D3013 D3013

Summary:

Summary Statement of Deficiencies D0000 An announced survey of the laboratory was conducted on 03/28/2024. The laboratory was found in compliance with applicable CLIA regulations (42 CFR Part 493, Requirements for Laboratories). STANDARD LEVEL DEFICIENCIES were cited. D3013 FACILITIES CFR(s): 493.1101(e) Records and, as applicable, slides, blocks, and tissues must be maintained and stored under conditions that ensure proper preservation. This STANDARD is not met as evidenced by: Based on surveyor's observations, review of laboratory's temperature/humidity logs, policies/procedures and staff interview, the laboratory failed to define and monitor Mohs slides' storage conditions for one of two rooms with slide storage. Findings included: 1. Surveyor's observations on 03/28/2024 at 1355 hours in the facility revealed Mohs slides were stored in two separate rooms, the designated laboratory, and a separate office. 2. Review of laboratory's temperature/humidity logs revealed the laboratory did not have documentation of monitoring slide storage conditions in the office. 3. Review of laboratory's policies/procedures revealed the laboratory did not have a protocol in place defining the storage conditions (temperature/humidity) for Mohs slides. 4. In an interview on 03/28/2024 at 1355 hours in the laboratory, the facility's Regional Manager (as indicated on submitted Survey Entrance/Exit document) 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 - May 3, 2022

Survey Type: Standard

Survey Event ID: J7IC11

Deficiency Tags: D0000 D5407 D6106 D5407 D5609 D5609 D6106

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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