Summary:
Summary Statement of Deficiencies D0000 An announced CLIA Validation survey was conducted at Dr Jons Urgent Care on May 2, 2019 by the Virginia Department of Health's Office of Licensure and Certification. The laboratory was surveyed under 42 CFR part 493 CLIA Requirements. Specific deficiencies cited are as follows: D6053 TECHNICAL CONSULTANT RESPONSIBILITIES CFR(s): 493.1413(b)(9) The technical consultant is responsible for evaluating and documenting the performance of individuals responsible for moderate complexity testing at least semiannually during the first year the individual tests patient specimens. This STANDARD is not met as evidenced by: Based on the review of Laboratory Personnel Report Form (CLIA) (CMS-209 Form), testing personnel (TP) records, and an interview with the technical consultant, the technical consultant (TC) failed to perform and document semi-annual competency assessments for one (1) of one (1) new TP in 2017. Findings include: 1. Review of the CMS-209 form revealed that the lab director also performs the duties of TC and that TP A was a new hire and performing patient testing in 2017. See attached TP code sheet. 2. Review of the TP A records revealed no documentation of a semi-annual competency assessment performed by the technical consultant in 2017. TP A had initial training assessment and competency performed April 29, 2017 and an annual competency assessment performed February 10, 2018. The inspector requested to review the semi-annual competency assessment. The documentation was not available for review. 3. An interview with the TC at approximately 12:30 PM 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 --